Lindström quantifier

Template:Infobox diagnostic Ambulatory blood pressure monitoring (ABPM) measures blood pressure at regular intervals. 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.

Blood pressure variability

24-hour, non-invasive ambulatory blood pressure (BP) monitoring allows estimates of cardiac risk factors including excessive BP variability or patterns of circadian variability known to increase risks of cardiovascular event.

Nocturnal hypertension

Ambulatory blood pressure monitoring allows blood pressure to be intermittently 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 and desirable. It correlates with relationship depth but other factors such as sleep quality, age, hypertensive status, marital status, and social network support. Absence of a night time dip is associated with poorer health outcomes, including increased mortality in one recent study. In addition, nocturnal hypertension is associated with end organ damage and is a much better indicator than the daytime blood pressure reading.

Target organ damage

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Overnight reduction or surge in blood pressure

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.

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

$Dip=(1-\frac{SB{P}_{Sleeping}}{SB{P}_{Waking}})*100\%$

Range	Class
<0%	Reverse Dipper
0% - 10%	Non-Dipper
10% - 20%	Dipper
>20%	Extreme Dipper

Dippers have significantly lower all-cause mortality than non-dippers or reverse dippers. As a result, "... ambulatory blood pressure predicts mortality significantly better than clinic blood pressure."

International Research

ARTEMIS http://www.artemisnet.org](international Ambulatory blood pressure Registry: TEleMonitoring of hypertension and cardiovascular rISk project) is the first International Ambulatory Blood Pressure Monitoring Registry aiming at assessing the actual degree of blood pressure and cardiovascular risk control of hypertensive patients followed by doctors all over Europe. The project is based on telemonitoring on BP through a web-based telemedicine service (MOREPRESS at www.morepress.net).

References

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External links

• ARTEMIS, international Ambulatory blood pressure Registry: TEleMonitoring of hypertension and cardiovascular rISk project
• Ambulatory blood pressure monitoring, Medical Journal of Australia