Ambulatory blood pressure monitoring: coming of age in nephrology.

The number of patients undergoing ambulatory blood pressure monitoring (ABPM) and the number of publications using this technique to evaluate the risks and effects of high blood pressure on target organs has been increasing, and dramatically so, in the last 5 years. Much of this growth has centered on the role of the blood pressure load (the percentage of systolic or diastolic readings above a preset value during a specific time period) and the changes in blood pressures levels that occur, with sleep. Although many studies are focused on the interaction between blood pressure (as assessed by ABPM) and the heart, interest is growing in the application of ABPM to the practice of nephrology. This paper discusses some of the technical aspects of ABPM, followed by a review of five areas of clinical research using ABPM, and which are relevant to renal medicine: microalbuminuria, renal function, renovascular hypertension, dialysis (hemodialysis and continuous ambulatory peritoneal dialysis), and transplantation. Despite a general lack of reimbursement for performance of the ABPM procedure, the growth in its usage and the willingness of clinicians to withhold or alter therapy on the basis of ABPM readings is testimony to its clinical value in the management of hypertension.