Ambulatory blood pressure monitoring. Can a clinical role be defined?

Automated ambulatory blood pressure monitoring (ABPM) is a powerful research tool, but its clinical role has been difficult to define. This paper presents conclusions on the potential clinical benefits, risks, and costs of ABPM based on a comprehensive review of the scientific literature. Support is strongest for the uses of ABPM to improve blood pressure (BP) classification in suspected hypertensives and in patients with apparent drug resistance. Four policy options are discussed. Approval for limited clinical applications appears warranted provided it is accompanied by 1) quality control standards for ABPM laboratories, 2) decision thresholds for equating office, self-monitored, and ABPM BP levels, and 3) steps to limit profit incentives and the high risk of overutilization.