From the Guidelines
The target for 24-hour ambulatory blood pressure monitoring should be less than 130/80 mmHg for the overall average, with daytime averages below 135/85 mmHg and nighttime averages below 120/70 mmHg, as recommended by the most recent and highest quality study 1.
Key Considerations
- Ambulatory blood pressure monitoring is a valuable tool for assessing true blood pressure levels, as it captures multiple readings throughout the day and night in a person's natural environment.
- The targets for ambulatory blood pressure monitoring are lower than traditional office-based measurements because ambulatory readings more accurately reflect a person's true blood pressure.
- For high-risk patients, such as those with diabetes, chronic kidney disease, or established cardiovascular disease, even lower targets may be appropriate, typically aiming for 24-hour averages below 125/75 mmHg.
Interpretation of Results
- When interpreting results, it's essential to consider the percentage of elevated readings in addition to the averages, with more than 30% of readings above threshold suggesting hypertension requiring treatment.
- The nocturnal dipping pattern, which should show a 10-20% decrease in blood pressure during sleep, is also an important factor to consider.
Clinical Applications
- Ambulatory monitoring can identify white coat hypertension (elevated readings only in clinical settings), masked hypertension (normal in-office readings but elevated elsewhere), and assess the nocturnal dipping pattern.
- The use of ambulatory blood pressure monitoring can help guide treatment decisions and improve patient outcomes, as it provides a more accurate assessment of blood pressure levels and cardiovascular risk 1.
From the Research
24-Hour Ambulatory Blood Pressure Monitoring Targets
- The American Heart Association 2017 guidelines and the European Society of Hypertension 2018 guidelines provide criteria for 24-hour ambulatory blood pressure measurements 2
- The most useful information from 24-hour ambulatory blood pressure monitoring includes:
- 24-hour average blood pressure
- Average daytime blood pressure
- Average nighttime blood pressure
- Calculated percentage drop in blood pressure at night 2
- Studies have shown that ambulatory blood pressure monitoring is superior to office blood pressure measurement in predicting hypertensive end-organ disease 3
- The level of 24-hour and nighttime blood pressure is what clinically matters most, while other blood pressure indexes derived from 24-hour ambulatory blood pressure recordings add little to risk stratification or hypertension management 4
Blood Pressure Targets
- The target blood pressure values are not explicitly stated in the provided studies, but it is mentioned that achieving the recommended blood pressure targets is crucial for reducing the burden of hypertension-related cardiovascular and renal diseases 5
- A study compared the effect of a moderate dose of angiotensin receptor blocker/calcium channel blocker combined with a diuretic versus a maximal dose of angiotensin receptor blocker with a diuretic on 24-hour ambulatory blood pressure monitoring, and found that the combination therapy was more effective in lowering nighttime and daytime blood pressure and reducing blood pressure load 6
Ambulatory Blood Pressure Monitoring
- Ambulatory blood pressure monitoring is a useful tool for assessing antihypertensive drugs and their combinations 6
- It is recommended that primary care physicians make more use of ambulatory blood pressure monitoring, especially in patients with difficult to manage hypertension 2
- Ambulatory blood pressure monitoring is cost-effective and can be used in conjunction with home blood pressure monitoring to provide a more comprehensive picture of a patient's blood pressure 4