Pittfalls in the 2017 acc/aha consensus blood pressure guidelines and the role of 24-hour ambulatory blood pressure monitoring

The American College of Cardiology and the American Heart Association (ACC/AHA) have just produced the 2017 Guidelines for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, which give only little consideration to ambulatory blood pressure monitoring (ABPM). It has been observed that ABPM can provide a better outcome in the diagnosis and in the pharmacotherapy of hypertension. Other potential BP markers, such as variability and instability in clinic BP, maximal rise in BP, masked hypertension, white-coat hypertension, nocturnal hypertension (“non-dippers”) and adequate control of BP by intensive drug therapy as well as prognosis can be addressed by ABPM. Definition of ABP targets for diagnosis and treatment of hypertension in relation to clinic BP is usually based on 24-to 48-hour records, which ignores the presence of circaseptan variability in BP and of alterations in BP variability, such as CHAT and ecphasia. These vascular variability disorders (VVDs) may be diagnosed by 7-day ABPM, which is important since presence of these anomalies carries large cardiovascular disease risk in their own right.