second-intl-consenus-meeting-on-24-hr-abpm - Eoin O'Brien

not approved for routine clinical use, 1,ut this situation
is changing rapidly. While most experts in the
field believe that ambulatory monitoring does have a
clinical role, there is also concern that the tecl~nique
might lx used excessively, particularly if the physician
has a direct financial incentive to perform the test.
'The number of patients wit11 questionable t~lood pressure
elevations is so enormous that it is important to
lay dow~ guidelines for the application of anlbulatory
blocxl pressure monitoring in clinical practice [13].
Special groups
Atnbulatory blocxl pressure n~onitoring may be par-
ticularly useful in determining the presence of hyper-
tension in chiltlren and adolescents, where tlie accu-
racy of diagnosis is of great importance, and in the
elderly, in whonl excessive treatment is particularly to
I>e ;~voitled [38]. Special considerations have also to
be given to the interpretation of 24-h hloocl pressure
profiles in blacks (101.
It might be anticipated that ambulatory monitoring
woulti be of value in the diagnosis of pregnancy-in-
duced hypertension, a condition in which measure-
ment of blood pressure by conventional methods is
unreliable. Indeed, it is hoped that the technique may
allow early identification of women at risk of develop-
ing pre-eclampsia, and this has promptecl a number
of studies [39-43], which have been summarized in
(44 I.
Prognosis
l'he most important question now awaiting an answer
is how accurate ambulatory blood pressure is in pre-
dicting long-term morbidity and mortality. l'here is ev-
idence that ambulatory blood pressure monitoring is
superior to conventional hlood pressure measurement
in this regard 1451, ant1 there is also evidence from
target organ endpoints that ambulatory I~loocl pres-
sure monitoring is better correlated with end-organ in-
volvement than clinic blood pressure is [12,31], but
the outcome of the longitudinal studies now under-
way must be awaited before the use of this technique
in the prognosis of hypertension can be determined
definitively.
Whereas many of the issues discussed at the Di11,lin
<strong>meeting</strong> eluded consensus for the moment, there was
general agreement that ambulatory blood pressure
measurement has moved from the research arena to
clinical practice, and that it is therefore essential to
ensure that guidelines are enacted regularly, retlecting
advancing knowlecige of the technique.
References
Consensus on 24-h ABPM Pickerin& O'Brien
1. WIIITE W3: Ambulatory hid pressure monitoring during
exercise and pliysical activity. J Il~prfens 1991, 9 (suppl
8):S22-S24.
2. PAUAI~ G, GROPEIJ~ A, OMnONI S, CASSADEI R, AlANClA G: Testing
tlie accuracy of blood pressure monitoring devices in
amhulatory conditions. J Ii)IwrIe~~s 1991, 9 (SIIII~I 8):S7-S9.
3. lut~ou. B, IANGWOI~~ G, PAUAII G, BT AL: Non-invasive.
continuous, twenty-four-hour blond pressure recording labstractj.
J fl~perferls 1991, 9 (suppl 8):S81.
4. RAFIFHY Ell: Direct verstls indirect measurement of blood
pressure. J /?)pertem 1991, 9 (suppl 8):SlO-S12.
5. O'HRIEN. E, MEE P, A ~INS N, O'MAIJEY K: Validation require-
6.
n~ents for an~b~~latory hlootl pressure meas~~ring systems. J
I[~;(wrfc?rs 1991, 9 (suppl 8):Sl %St 5.
VAN E(;I!RI.:N LF: Monitoring activity and hlocwl pressure. J
I[19wrtets 1991, 9 (suppl 8):S25-S27.
7. Cox~s AJS, CIAHK S, CONWAY J: Analysis of an~hulatory blootl
pressure clata. J II)~wrtetls 1991. 9 (suppl 8):S13-S21.
8. S.I.AESSEN J. CEUS Ii, DE Coar P, FAGAIUI R, I'IIIJS L, A~~EKY A:
Methods for describing the diurnal blood pressure curve.
J Ii)pcrfera 1991, 9 (suppi 8):SlbS18.
9. I'ICKERING TG, SCI~NNL 1'1, SCIIWAH'IZ JE, PIEPEH CF: Can be-
Iiaviour:~l factors produce a sustained elevation of hloocl
pressure? Some olservations and a I~ypntliesis. J I~pcrferrs
19)l. 9 (sul'pl 8):SS68.
10. MIIRPIIY MI), PIIMO MT, GKI.:'~IEH DD, NELWN KS, IANG RM: Diurnal
b l d pressure variation: differences among disparate
ethnic groups. J f!)@rfetn 1991, 9 (suppi 8):S45-547.
, 11. PAIWIEII) PL. SIXWART MI: Ambulatorv blood Dressure monitoring
in <strong>second</strong>ary Ilypenension. J II'JprIetrr 1991,9 (suppl
8):S69-71.
12. Vlimecclll~ P, .%~III~ACI G, Po~cellsn C: Dippers versus non-
13.
dippers. J I!)pertet~~ 1991, 9 (suppl 8):S42-S44.
O'I3HleN E, Cox J, O'Mnuau K: The role of twenty-fourhour
ambulatory blood pressure measurement in clinical
practice. J 1~)prtetrr 1991, 9 (suppl 8):.%3S65.
14. REID J, RAINBRIWE AD, MACFADYEN KJ: The contribution by
ambulatory hlcxxl pressure measurement to the evaluation
of new antihypertensive dr~~gs. J IiHwrtens 1991, 9 (suppl
S):S54-S%.
15. CONWAY J, COATS AJS: Ambulatory b l d pressure monitoring
in the design of antihypertensive drug trials. J II'Jperle?rr
1991, 9 (suppl 8):S57-S58.
16. IIPICKY RJ: The United States Rmd and Drug Administration
guitlelines on ambulatory hlcd pressure monitoring.
.I I/)pcrferu 1991, 9 (suppl 8):S59.
17. MEYI!R-SAUICIJEK W: Proposals for European Community
guidelines in the use of ambulatory blcmd pressure monitoring
to evduate antihypertensive dn~gs. J Iljperrens 1991,
9 (suppl H):S6(M62.
18. Ci~lllcln~ S(;, McCs~nl RP. ME GAUDEMAHIS It, I)Al-lls~lJ~ P, PONCEIET I', ET AL: Arnbulatory
hlotd pressure reference data from a nomotensive
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21. Goss~ P, IAMAISON C, ROUIIANI' R, DNI~CI~IO M: Amhula-
22.
tory blood pressure monitoring in a normal population
[abstract]. J If)prfefrs 1991, 9 (suppl 8):SH3-%4.
Hntrhlcrun. P: Ambulatory blml pressure monitoring: reference
values and the standard hltml pressure scale lab.
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23. O'URWN E, Mrlnl~tw J, TYNI)AIL A, ET AL: Twenty-four-hour
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