Ambulatory blood pressure

WikiDoc Resources for Ambulatory blood pressure

Articles

Most recent articles on Ambulatory blood pressure

Most cited articles on Ambulatory blood pressure

Review articles on Ambulatory blood pressure

Articles on Ambulatory blood pressure in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Ambulatory blood pressure

Images of Ambulatory blood pressure

Photos of Ambulatory blood pressure

Podcasts & MP3s on Ambulatory blood pressure

Videos on Ambulatory blood pressure

Evidence Based Medicine

Cochrane Collaboration on Ambulatory blood pressure

Bandolier on Ambulatory blood pressure

TRIP on Ambulatory blood pressure

Clinical Trials

Ongoing Trials on Ambulatory blood pressure at Clinical Trials.gov

Trial results on Ambulatory blood pressure

Clinical Trials on Ambulatory blood pressure at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Ambulatory blood pressure

NICE Guidance on Ambulatory blood pressure

NHS PRODIGY Guidance

FDA on Ambulatory blood pressure

CDC on Ambulatory blood pressure

Books

Books on Ambulatory blood pressure

News

Ambulatory blood pressure in the news

Be alerted to news on Ambulatory blood pressure

News trends on Ambulatory blood pressure

Commentary

Blogs on Ambulatory blood pressure

Definitions

Definitions of Ambulatory blood pressure

Patient Resources / Community

Patient resources on Ambulatory blood pressure

Discussion groups on Ambulatory blood pressure

Patient Handouts on Ambulatory blood pressure

Directions to Hospitals Treating Ambulatory blood pressure

Risk calculators and risk factors for Ambulatory blood pressure

Healthcare Provider Resources

Symptoms of Ambulatory blood pressure

Causes & Risk Factors for Ambulatory blood pressure

Diagnostic studies for Ambulatory blood pressure

Treatment of Ambulatory blood pressure

Continuing Medical Education (CME)

CME Programs on Ambulatory blood pressure

International

Ambulatory blood pressure en Espanol

Ambulatory blood pressure en Francais

Business

Ambulatory blood pressure in the Marketplace

Patents on Ambulatory blood pressure

Experimental / Informatics

List of terms related to Ambulatory blood pressure

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview[edit | edit source]

Ambulatory blood pressure monitoring (ABPM) measures blood pressure at regular intervals throughout the day and night. It is believed to be able to reduce the white coat hypertension effect in which a patient's blood pressure is elevated during the examination process due to nervousness and anxiety caused by being in a clinical setting. Out-of-office measurements are highly recommended as an adjunct to office measurements by almost all hypertension organizations.[1].

## Nocturnal Hypertension[edit | edit source]

Ambulatory blood pressure monitoring allows blood pressure to be continually monitored during sleep, and is useful to determine whether the patient is a dipper or non-dipper, that is to say whether or not blood pressure falls at night compared to daytime values. A night time fall is normal. It correlates with relationship depth but other factors such as sleep quality, age, hypertensive status, marital status, and social network support.[2] Absence of a night time dip is associated with poorer health outcomes, including increased mortality in one recent study.[3] In addition, nocturnal hypertension is associated with end organ damage[4] and is a much better indicator than the daytime blood pressure reading.

## Target Organ Damage[edit | edit source]

Template:Seealso It has been shown that end-organ damages related to hypertension, such as left ventricular hypertrophy, narrowing of the retinal arteries are more strongly associated with ABPM than with a clinical BP measurement, the reason being clinical BP measurement are referred to the marked variability of BP measurement and white coat effect [5][6][7][8][9].

## Morning Surge[edit | edit source]

Optimal blood pressure fluctuates over a 24-hour sleep-wake cycle, with values rising in the daytime and falling after midnight. The reduction in early morning blood pressure compared with average daytime pressure is referred to as the night-time dip. Ambulatory blood pressure monitoring may reveal a blunted or abolished overnight dip in blood pressure. This is clinically useful information because non-dipping blood pressure is associated with a higher risk of left ventricle hypertrophy and cardiovascular mortality. By comparing the early morning pressures with average daytime pressures, a ratio can be calculated which is of value in assessing relative risk. Dipping patterns are classified by the percent of drop in pressure, and based on the resulting ratios a person may be clinically classified for treatment as a "non-dipper" (with a blood pressure drop of less than 10%), a "dipper," an "extreme dipper," or a "reverse dipper," as detailed in the chart below. Additionally, ambulatory monitoring may reveal an excessive morning blood pressure surge; which is associated with increased risk of stroke in elderly people with high blood pressure.[10][11]

Classification of dipping in blood pressure is based on the American Heart Association's calculation, using systolic blood pressure (SBP) as follows:

Dip = (1 - {SBRsleeping/SBPwaking}) * 100%
Range  | Class

|

<0%  | Reverse Dipper
0% - 10%  | Non-Dipper
10% - 20%  | Dipper
>20%  | Extreme Dipper

## Blood Pressure Variability[edit | edit source]

24-hour, non-invasive ambulatory blood pressure monitoring allows estimates of BP variability.

## References[edit | edit source]

1. ↑ Verdecchia P, Angeli F, Gattobigio R (2004). "Clinical usefulness of ambulatory blood pressure monitoring". J. Am. Soc. Nephrol. 15 Suppl 1: S30–3. PMID 14684668. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
2. ↑ Holt-Lunstad J, Jones BQ, Birmingham W. (2009).The influence of close relationships on nocturnal blood pressure dipping. Int J Psychophysiol. 71(3):211-7. doi:10.1016/j.ijpsycho.2008.09.008 PMID 18930771
3. ↑ Minutolo R, Agarwal R, Borrelli S, Chiodini P, et al (2011). Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease. Arch Intern Med. 171(12):1090-8.
4. ↑ Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society
5. ↑ Clinical Usefulnesses of Ambulatory Blood Pressure Monitoring, Paolo Verdecchia, Fabio Angeli, Roberto Gattobigio
6. ↑ Doménech M, Berruezo A, Molina I, Mont L, Coca A (2013). "Nighttime Ambulatory Blood Pressure is Associated With Atrial Remodelling and Neurohormonal Activation in Patients With Idiopathic Atrial Fibrillation". Rev Esp Cardiol. doi:10.1016/j.recesp.2012.11.011. PMID 23427898. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
7. ↑ Silva-Néto RP, Bernardino SN (2013). "Ambulatory Blood Pressure Monitoring in Patient With Hypnic Headache: A Case Study". Headache. doi:10.1111/head.12066. PMID 23425041. Unknown parameter `|month=` ignored (help)
8. ↑ Krakoff LR (2013). "Ambulatory blood pressure improves prediction of cardiovascular risk: implications for better antihypertensive management". Curr Atheroscler Rep. 15 (4): 317. doi:10.1007/s11883-013-0317-9. PMID 23423525. Unknown parameter `|month=` ignored (help)
9. ↑ Luo Y, Wang YL, Wu YB; et al. (2013). "Association between the rate of the morning surge in blood pressure and cardiovascular events and stroke". Chin. Med. J. 126 (3): 510–4. PMID 23422116. Unknown parameter `|month=` ignored (help)CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
10. ↑ Morning surge in blood pressure linked to strokes in elderly
11. ↑ Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives

## External Links[edit | edit source]

* Ambulatory blood pressure monitoring at Medical Journal of Australia

Template:WikiDoc Sources CME Category::Cardiology