Bettering blood pressure control in clinical practice: role of ambulatory blood pressure monitoring

The routine clinical use of ambulatory blood pressure monitoring (ABPM) is still controversial, mainly because this technique adds a considerable cost to the already expensive treatment of hypertension. However, considering that epidemiological surveys still indicate that well-controlled hypertensive patients are only a minority, all the tools that may potentially ameliorate BP control should be considered for clinical practice. The aim of the present study was to assess the prevalence of satisfactory blood pressure (PB) control in patients followed up with ABPM in our hypertension unit. We retrospectively analyzed BP control levels in 120 consecutive patients who had been routinely controlled with ABPMs performed every 6–12 months. Inclusion criteria were: sustained mild-moderate hypertension with a duration ≥3 years, continuous pharmacological treatment and at least 3 valid ABPMs in the last 2 years. A 24-hour mean BP < 135/85 mm Hg was considered as effective BP control. The results have been compared with those obtained in a group of 120 patients (comparable as far as age, gender distribution, duration of hypertension are concerned) controlled through clinic BP and who underwent their first ABPM in our unit. Seventy-two percent of the 120 hypertensive patients followed up with ABPM showed well controlled BP, while in the control group only 38% had satisfactory BP levels (p < 0.001, Fisher's exact probability test). Fourteen percent of the patients who regularly underwent ABPM were taking more than 2 antihypertensive drugs, while 28% of the patients followed up with clinic BP measurements were taking more than 2 drugs. Our data indicate that, in a specialized clinic, the routine use of ABPM in mild-moderate hypertensive patients may significantly improve BP control. ABPM, providing more detailed and repeatable information on blood pressure status, might also reduce the need of polypharmacotherapy which may consistently affect patients’ compliance and, therefore, BP control.