Ambulatory blood pressure monitoring (ABPM) is an essential component of the clinical evaluation of patients with hypertension. Without any doubt ABPM plays an important role in avoiding misclassification of blood pressure (white coat hypertension or masked hypertension). This is also true for children and adolescents where up to 20% of hypertensives would not be detected without ABPM. Furthermore, ABPM is the only commonly used non-invasive method to determine nocturnal blood pressure. Prerequisites are the use of a validated system, e. g. International Protocol 2 of the European Society of Hypertension (ESH) or seal of approval by the German Hypertension League (DHL), the correct indications, a precise devided carried programming and the correct classification of blood pressure according to the DHL criteria. The blood pressure is into six classes ranging from " optimal" to " hypertension severity grade 3" It seems advisable to use these analogue values for the individual cardiovascular risk stratification as end-organ damage associated with hypertension is more closely related to ABPM and this procedure thus gives a better prediction of clinical outcome than clinical blood pressure measurements.The technique and clinical use of ABPM should follow certain standards to obtain valid results. Interpretation of ABPM profiles and norm values are discussed in this paper. Additionally some new parameters which have been published during recent years are described and discussed.
Die ambulante 24-h-Langzeitblutdruckmessung (ABDM) ist für die Diagnose und Therapieüberwachung der Hypertonie unverzichtbar. Sie trägt entscheidend dazu bei, eine Unter- bzw. Überschätzung des Blutdruckniveaus zu vermeiden. Der diagnostische und prognostische Wert des Verfahrens ist gesichert. Voraussetzung ist allerdings, dass alle Vorgaben erfüllt werden: die richtige Indikationsstellung, die ordnungsgemäße Programmierung und Durchführung der Messung, die korrekte Klassifikation des Blutdruckniveaus. Die ABDM bildet dann das kardiovaskuläre Risiko deutlich besser ab als die Blutdruckmessung in der Praxis. Eine schriftliche Beurteilung durch den Arzt ist obligat.
Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study
