How can we use the results of ambulatory blood pressure monitoring in clinical practice?

After the landmark study by Perloff et al, 1 other investigations showed that ambulatory blood pressure (ABP) is superior to office blood pressure (BP) for cardiovascular risk stratification in untreated and treated hypertensive subjects.2,3 Also as a consequence of these outcome-based studies, Medicare and Medicaid approved limited and partial ABP monitoring for reimbursement in patients with suspected white coat hypertension (WCH), considering the technique necessary to determine the appropriate management of the patient. In this issue of Hypertension,4 Dolan et al extend the current database on the prognostic value of ABP in hypertensive subjects with the results of the Dublin Outcome Study, a large observational registry of subjects who underwent ABP before treatment and were subsequently followed-up for up to 20 years. Most of these subjects had elevated office BP at entry. During the follow-up period there were 646 deaths, 389 of which were caused by cardiovascular causes, and this huge number provided the opportunity to examine for the first time the value of ABP for prediction of cardiovascular mortality in a large population. After correction for other risk factors, ABP was superior to office BP for prediction of cardiovascular mortality and nighttime ABP was the most potent ABP component for prediction of outcome.