METHODOLOGICAL AND DIAGNOSTIC RELIABILITY OF 24-H ABPM: A PARADIGM SHIFT IN DAILY CLINICAL PRACTICE?

Abstract

Objective: Blood pressure measurementst form the cornerstone of diagnosing, treating, and researching arterial hypertension. The 24-hour ambulatory blood pressure monitoring (24-h ABPM) is widely considered best practice, but challenges such as availability and cost persist. This study evaluates the validity, accuracy, and practicality of ABPM in clinical settings. Design and method: Retrospectively analyzing 450 24-h ABPM measurements from the Nephrology Center Göttingen, using validated devices from I.E.M. and BOSO, this study assesses adherence to European Society of Hypertension (ESH) and German Hypertension Society (DHL) guidelines. Criteria include a minimum 24-hour recording, at least 20 valid day and 7 valid night measurements, and a minimum of 70% overall validity. Patient cancellations are considered if measurements end before 7:30 a.m. or last less than 22 hours without technical faults. Results: Only 23% (n=106) of ABPMs met all guideline criteria; 77% failed at least one criterion. In 27% (n=120) of cases, duration was below 24 hours, and in 22% (n=98), it was below 22 hours. Motion artifacts caused validity failures in 50%, daytime pressurization issues in 17%, and nighttime issues in 27%. Patient cancellations constituted 20.6% (n=93), with adipose patients 40% more likely to cancel. Diabetes and severe hypertension correlated with a 40% reduction in guideline-conforming measurements. Sixteen percent (n=72) were canceled without recording early morning blood pressure, correlating strongly with cardiovascular risk. Conclusions: The study emphasizes the importance of correct ABPM execution, urging explicit discussions with patients. Acknowledging ABPM limitations, the paper recommends additional methods like telemetrically transferred blood pressure measurements at home (idTM) for intervention options. Given the variability in ABPM data quality, its validity must be scrutinized case by case. The findings advocate for increased use of home blood pressure measurements, aligning with current guidelines for diagnostics and therapy.