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Clinical significance and cost-effectiveness of 24-hour ambulatory blood pressure monitoring.

Ambulatory blood pressure (BP) monitoring as an adjunct to casual/clinic BP measurements is currently used widely for the diagnosis and treatment of hypertension. It has been established that ambulatory BP monitoring is essential to confirm "white coat" hypertension, drug-resistant hypertension, duration of drug action, short-term BP variation, and nocturnal and on-the-job BP levels. It is estimated that approximately 10,000 ambulatory BP monitoring devices are currently used in Japan. That number would increase if 1) a standard algorithm with a theoretical basis to determine BP levels is introduced for ambulatory BP monitoring devices based on cuff-oscillometric method, 2) the reproducibility of ambulatory BP levels is confirmed, 3) reference values for evaluating ambulatory BP monitoring levels are established, and 4) the clinical significance and prognostic value of ambulatory BP monitoring is established. If such problems is settled, the use of ambulatory BP monitoring in the diagnosis and treatment of hypertension would be national health insurance and would improve the prognostic accuracy of evaluating hypertension as well as the cost-effectiveness of screening, diagnosis and treatment of hypertension.