Relationship between ambulatory and exercise blood pressure and cardiac structure.

Recent research using automated ambulatory blood pressure recorders and echocardiography has revealed a closer relationship between LV structure and blood pressure during usual activity than with physician measurements of blood pressure. Because increased LV mass is a strong predictor of an adverse prognosis, this suggests that ambulatory blood pressure may also be more predictive of prognosis than casual readings, a view supported by preliminary evidence. Ambulatory blood pressure monitoring has already proved useful to identify patients with "white coat" hypertension or "office" hypertension, whose hearts appear normal by echocardiography. Further research is needed to determine the relative predictive value and comparative cost-effectiveness of ambulatory blood pressure monitoring and echocardiography for identification of patients in whom hypertension does or does not constitute a cardiovascular disease that requires antihypertensive therapy.