1. Use of ABPM to diagnose hypertension
Professor Colin P Bradley
Department of General Practice
University College Cork

3. Factors that influence office blood pressure readings
Time of day
Patient anxiety
Patient activity
Cuff size
Device calibration
Medication
Recent eating
Recent alcohol consumption
Caffeine
Bladder fullness
Smoking

4. The case for ABPM More data – better information
Detection of ‘white coat hypertension’
20-25% across a range of studies
Detection of other abnormalities of blood pressure regulation
Masked hypertension
Lack of nocturnal dipping
Better predictor of cardiovascular outcomes

5. NICE guideline on diagnosis Hypertension 127 - August 2011
If clinic blood pressure is >140/90 use ABPM (or HBPM) for diagnosis of hypertension
If severe hypertension (clinic reading i.e. sys >180 or dia >110) start anti-hypertensive treatment without awaiting ABPM/HBPM
Check for end organ damage & assess cardiovascular risk while awaiting result of ABPM
ABPM – 2 readings per hour waking; 1 per hour sleeping
HBPM – 2 readings each time; record at least twice per day (am &pm) for minimum 4, ideally 7 days (discard first day readings)

6. NICE Guidelines – evidence base
Review question: In adults with suspected primary hypertension, what is the best method to measure blood pressure (HBPM versus ABPM versus CBPM) to predict the development of cardiovascular events?

10. NICE guidelines – evidence base
Review question: In adults with suspected primary hypertension, what is the best method to measure blood pressure (HBPM versus ABPM versus CBPM) to establish the diagnosis of hypertension?

18. White coat hypertension

19. Hypertensive -normal dipper pattern

20. Hypertensive – reverse-dipper

21. Abnormalities revealed by ABPM
White coat hypertension/ white coat effect
Masked hypertension
Non-dipping
Reverse dipping
Morning surge

22. ABPM abnormalities in diabetes
Less white coat hypertension
More masked hypertension
More non-dipping
More reverse dipping
More morning hypertension (? with diabetic nephropathy)

23. ABPM thresholds in diabetes
Hermida et al
120/70mmHg waking
105/60mmHg asleep
Cardoso et. al.
mean daytime blood pressure of 125/75mmHg
110/65mmHg for night-time
120/75mmHg for the 24hr mean.

24. Challenges in ABPM Cost Time Device calibration & maintenance
Device failure
Patient feasibility &acceptability
Interpretation of readings
Arrhythmias (esp a. fib)
Follow up – are clinic readings ok?