Too much of a good thing? A critique of overemphasis on the use of ambulatory blood pressure monitoring in clinical practice.

Ambulatory blood pressure monitoring (ABPM) can be considered a major achievement in clinical medicine. However, its superiority over traditional clinical measurement has often been overemphasized in the literature. In both cross-sectional and longitudinal studies, ABPM has been compared with clinical blood pressure calculated from only a few readings taken over a short period of time. For reasons of costs and practicality, ABPM should not be considered as a routine test in the assessment of the hypertensive patient. Most patients with borderline hypertension or isolated clinical hypertension can be profitably assessed with multiple clinical readings and self-blood pressure monitoring. Patients with large short-term or long-term blood pressure oscillations appear as optimal candidates to ABPM. The many methodological problems associated with the use of this technique suggest that ABPM is performed only by experienced doctors.