Marc De Buyzere

Should Antihypertensive Treatment be Guided by Casual Measurement or Trough ABPM

Several reliable, convenient, easy to use, validated commercial ambulatory blood pressure (ABP) monitors are now currently available on the market. However, most recommendations, such as those from the Ad Hoc panel of the American Society of Hypertension, the National High Blood Pressure Education Program Coordinating Committee and the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure restrict ABP to specific conditions. They advise that ABP should not be used indiscriminately for the routine evaluation and management of the hypertensive patient. Most important conditions in which ABP was thought to be helpful included suspected white coat hypertension (WCH), apparent drug resistance, hypotensive symptoms while on antihypertensive drugs, episodic hypertension and autonomic dysfunction (1,2). Individual authors sometimes have more extended lists of clinical indications such as borderline hypertension with target organ damage, orthostatic hypotension and so on (3). All of them agree that ABP is an excellent technique to monitor clinical drug trials, strongly reducing the placebo effect (Table l).Nevertheless, many investigators in the field have the strong feeling that these are not the final indications and that the answer to the question whether or not the management of the hypertensive patient should be guided by ABP is now turning into a new direction.