ABPM Is Valuable for the Management of Hypertension

Both the article by Grandi et al¹ showing that patients with IOH, or white-coat hypertension, had increased left ventricular mass and the accompanying editorial² recommending that patients with IOH should be given medication misrepresent the relationship between ABPM and echocardiographic assessment of left ventricular mass as found in many larger and better-designed studies. Furthermore, Dr Moser's extrapolation of the results of this single study¹ to long-term outcomes avoids the central issue: which assessments of BP best predict future cardiovascular morbidity and mortality and provide some basis for selecting treatment? Abundant epidemiologic surveys indicate that the long-term average BP, corrected for regression dilution, is the best predictor of risk.³ Short-term measurement of office BPs, especially when they are near cutoff points for normal, all too often result in a false-positive diagnosis of hypertension.⁴ Hence, supplemental BP readings, taken at home with reliable methods or with ABPM, provide more precise averages. These BP readings are better correlated with future cardiovascular mortality and morbidity than are clinic BP readings.^5- 6 These less biased and more accurate measurements should be the basis for treatment, especially in younger subjects (as in Grandi and colleagues' study), who have nothing to gain from antihypertensive drug treatment in the immediate future.