Classic papers symposium: ambulatory blood pressure monitoring and hypertensive target organ damage.

Despite tremendous advances in detection and treatment, including both non-pharmacologic and pharmacologic methods, hypertension continues to be a major health concern. In addition to efforts at reducing mortality, recent clinical and research attention has been focused on reducing morbidity from hypertension. Therefore, such efforts are focused on the effect of an elevated blood pressure on individual target organs and in particular on the heart, brain, and kidney. Although the role of blood pressure reduction alone in preserving target organ damage from hypertension is intensely debated, there is little debate that reducing blood pressure is important. The primary manner in which the blood pressure level is determined in the clinical setting continues to be the casual office measurement of blood pressure. However, the clinical use of ambulatory blood pressure determinations, including 24-hour automated blood pressure monitoring, is increasing. Recent data suggest that the determination of ambulatory blood pressures may be a better predictor not only of mortality but also of target organ damage from hypertension. This article will review recent key clinical studies addressing the role of ambulatory blood pressure on certain cardiac, cerebral, and renal manifestations of hypertension.