Is ambulatory blood pressure monitoring useful in patients with chronic autonomic failure?

Management of blood pressure (BP) abnormalities in patients with autonomic failure is usually based on office BP readings. It is uncertain, whether office readings reflect actual BPs during a typical day. Therefore, in 45 patients with autonomic failure, we compared office BP values during a tilt test with those captured on a 24-h ambulatory monitor. Office BP values while supine predicted well the level of nighttime hypertension. However, in only 33 % of patients, office values during tilt test accurately reflected hypotension during a typical day. Therefore, ambulatory monitoring is useful to gauge the true severity of hypotension in patients with autonomic failure.