What are the recommended indications for using ambulatory blood pressure monitoring (ABPM) in primary care?

Recommended indications for using ambulatory blood pressure monitoring (ABPM) in primary care include:

• Confirming a diagnosis of hypertension when clinic blood pressure readings are between 140/90 mmHg and 180/120 mmHg, as ABPM provides a more accurate assessment by averaging multiple readings during usual waking hours, requiring at least 14 measurements with a minimum of 2 per hour (08:00–22:00) NICE NG136.
• Identifying white-coat hypertension or masked hypertension, where clinic and out-of-clinic blood pressure measurements conflict, to avoid misdiagnosis and inappropriate treatment NICE NG136.
• When home blood pressure monitoring (HBPM) is unsuitable or not tolerated by the patient, ABPM is the preferred alternative for confirming hypertension diagnosis NICE NG136.
• Assessing blood pressure variability and nocturnal hypertension, which are better captured by ABPM than clinic or home measurements, aiding in cardiovascular risk stratification and management decisions Parati et al. 2014.
• Evaluating treatment efficacy and adherence in patients with diagnosed hypertension, especially when clinic readings do not correlate with symptoms or suspected control issues Mazalovic et al. 2018.

ABPM is considered the gold standard for out-of-office blood pressure measurement due to its ability to reduce misclassification from white-coat effects and provide comprehensive blood pressure profiles over 24 hours Shin et al. 2020. In primary care, its use is supported to improve diagnostic accuracy and guide management, aligning with NICE recommendations to confirm hypertension diagnosis before initiating treatment NICE NG136.