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| | Name = Ambulatory blood pressure
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| '''Ambulatory blood pressure''' monitoring (ABPM) measures [[blood pressure]] at regular intervals.<ref>[http://www.watchbp.com/fileadmin/pdf/abstracts/study_o3_validation.pdf Validation of the Microlife WatchBP O3 device for clinic, home and ambulatory blood pressure measurement, according to the International Protocol]</ref> 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.
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| ==Blood pressure variability==
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| 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.
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| ==Nocturnal hypertension==
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| 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.<ref>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</ref> Absence of a night time dip is associated with poorer health outcomes, including increased mortality in one recent study.<ref>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.</ref> In addition, nocturnal hypertension is associated with end organ damage<ref>[http://www.bmj.com/cgi/content/full/320/7242/1128 ''Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society'']</ref> and is a much better indicator than the daytime blood pressure reading.
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| ==Target organ damage==
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| {{see also|End organ damage}}
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| Readings revealing possible hypertension-related [[end organ damage]], such as left ventricular hypertrophy or narrowing of the retinal arteries, are more likely to be gained through ambulatory blood pressure monitoring than through clinical blood pressure measurement. Clinical BP measurements are fewer in number, and so more subject to the general marked variability of BP measurements. Additionally, clinical measurements are affected by the "white coat effect" - the rise in blood pressure many patients experience due to the stress of being in the medical situation.<ref>{{cite journal |author=Verdecchia P, Angeli F, Gattobigio R |title=Clinical usefulness of ambulatory blood pressure monitoring |journal=[[J. Am. Soc. Nephrol.]] |volume=15 Suppl 1 |issue= |pages=S30–3 |year=2004 |pmid=14684668 |doi= |url=http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=14684668 |accessdate=2008-12-01}}</ref>
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| ==Overnight reduction or surge in blood pressure==
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| 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.<ref>[http://www.americanheart.org/presenter.jhtml?identifier=3009554 ''Morning surge in blood pressure linked to strokes in elderly'']</ref><ref>[http://hyper.ahajournals.org/cgi/content/full/38/4/852 ''Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives'']</ref>
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| Classification of dipping in blood pressure is based on the American Heart Association's calculation, using [[systolic blood pressure]] (SBP) as follows:
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| :<math>Dip = (1 - \frac{SBP_{Sleeping}}{SBP_{Waking}}) *100% </math>
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| {| class="wikitable"
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| |-
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| ! Range
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| ! Class
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| |-
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| | <0%
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| | Reverse Dipper
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| |-
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| | 0% - 10%
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| | Non-Dipper
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| |-
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| | 10% - 20%
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| | Dipper
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| |-
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| | >20%
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| | Extreme Dipper
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| |}
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| 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."<ref name=Ben-Dov>{{cite journal|last=Ben-Dov|first=Iddo Z.|coauthors=Jeremy D. Kark, Drori Ben-Ishay, Judith Mekler, Liora Ben-Arie, Michael Bursztyn|title=Blood Pressure Measurement and Cardiovascular Risk Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring Unique Aspects of Blood Pressure During Sleep|journal=Hypertension|date=March 26, 2007|volume=49|pages=1235–1241|doi=10.1161/HYPERTENSIONAHA.107.087262 (Free Full Text)|pmid=17389258|url=http://hyper.ahajournals.org/content/49/6/1235.long|accessdate=9 March 2013}}</ref>
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| ==International Research==
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| ARTEMIS http://www.artemisnet.org](international '''A'''mbulatory blood pressure '''R'''egistry: '''TE'''le'''M'''onitoring of hypertension and cardiovascular r'''IS'''k 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).
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| ==References==
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| {{reflist}}
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| ==External links==
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| *[http://www.artemisnet.org ARTEMIS], international Ambulatory blood pressure Registry: TEleMonitoring of hypertension and cardiovascular rISk project
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| *[http://www.mja.com.au/public/issues/176_12_170602/mcg10817_fm.html Ambulatory blood pressure monitoring], Medical Journal of Australia
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| {{DEFAULTSORT:Ambulatory Blood Pressure}}
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| [[Category:Blood pressure]]
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