Using out of office blood pressure monitoring in the management of hypertension.

Self-measurement of blood pressure (BP) and 24-hour ambulatory BP monitoring (ABPM) are increasingly used in order to improve cardiovascular risk stratification over and beyond traditional methods, including sphygmomanometric BP measurement. Self-measured BP has the advantage of being cheap, quite representative of the usual BP over long periods of time, and devoid of the "white coat" effect. Only a few data exist on the prognostic value of self-measured BP. Most of the outcome studies with 24-hour ABPM have been conducted in patients with essential hypertension who were untreated at the time of execution of ABPM. Cardiovascular risk showed a direct association with ambulatory BP and an inverse association with the degree of BP reduction from day to night. White coat hypertension versus ambulatory hypertension and dippers versus nondippers are two classifications based on arbitrary operational risk categories. ABPM may be valuable for refining cardiovascular risk stratification in untreated subjects with office hypertension, as well as those with resistant hypertension.