II monitoraggio ambulatoriale della pressione arteriosa nella pratica clinica [Ambulatory blood pressure monitoring in clinical practice]

Traditionally, diagnosis and management of arterial hypertension are based on blood pressure (BP) measurements taken in the physician's office. However, 24-h noninvasive ambulatory BP monitoring is increasingly used in patients with essential hypertension. Several prospective studies provided unequivocal evidence of an independent association between ambulatory BP and risk of cardiovascular disease in the general population and hypertensive patients. Ambulatory BP is a better predictor of cardiovascular morbidity and mortality than office BP after adjustment for traditional cardiovascular risk factors such as age, sex, smoking status, baseline office BP, and use of antihypertensive drugs. The more accurate prognostic value of ambulatory BP may be related to the closer association with hypertension-related organ damage such as left ventricular mass, intima-media thickness, and microalbuminuria. The superiority of ambulatory over clinic BP in predicting clinical outcome and the most appropriate way of interpreting results of ambulatory BP monitoring will be discussed in this review.