Advantages of Ambulatory Blood Pressure Monitoring in Assessing the Efficacy of Antihypertensive Therapy

The cumulative evidence in the past three decades situates ambulatory blood pressure monitoring (ABPM) as a central element in diagnosing and predicting the prognosis of subjects with hypertension. However, for various reasons, this diagnostic and prognostic importance has not been translated in equal measure into making decisions or guiding antihypertensive treatment. Mean 24-h, daytime, and night-time blood pressure estimates, the occurrence of divergent phenotypes between clinic measurements, and ABPM, as well as the main elements that determine blood pressure variability over 24 h, especially night-time dipping, are all elements that in addition to providing evidence for patient prognosis, can be used to guide antihypertensive treatment follow-up enabling greater precision in defining the effect of the drugs. In recent years, specific indices have been developed using 24-h monitoring, evaluate the duration of treatment action, the homogeneity of the effect over the monitoring period, and its possible effects on variability. In future controlled clinical trials on antihypertensive therapies it is necessary to evaluate the effects of those treatments on hard endpoints based on therapy guided by ABPM.