MANAGEMENT OF HYPERTENSION AFTER AMBULATORY BLOOD-PRESSURE MONITORING

Objective: To study the test-ordering behavior of practicing physician s regarding ambulatory monitoring of blood pressure and to assess chan ges in patient management after this study. Design: Cross-sectional as sessment of physicians' practice habits regarding the ordering of ambu latory blood pressure monitoring and a longitudinal study of patient m anagement after monitoring. Setting: Physicians' offices in central Co nnecticut. Participants: Two hundred thirty-seven consecutive patients referred by 65 community- and hospital-based physicians. Measurements : Indications for ambulatory blood pressure monitoring, changes in dia gnosis and therapy, and office blood pressures before and after the am bulatory blood pressure study. Results: The main indications for order ing the test included borderline hypertension (27% of studies ordered) , assessment of blood pressure control during drug therapy (25%), eval uation for ''white coat'' or ''office'' hypertension (22%), and drug-r esistant hypertension (16%). After the ambulatory blood pressure study , only 13% of the patients had further testing (for example, echocardi ography); the diagnosis was changed in 41% of the patients, and antihy pertensive therapy was changed in 46%. In 122 patients for whom data w ere complete, office blood pressure measured by the referring physicia n decreased from 161/96 +/- 22/12 mm Hg before the ambulatory blood pr essure study to 151/86 +/- 27/12 mm Hg 3 months after the study (P = 0 .004 for systolic blood pressure and P < 0.001 for diastolic blood pre ssure). One to 2 years after the study, office blood pressure was 149/ 86 +/- 24/12 mm Hg (P > 0.2 compared with 3 months after the study). S eventy-two percent of the patients had a lower office blood pressure w ithin 3 months of the ambulatory blood pressure study. Conclusions: Pr acticing physicians use ambulatory blood pressure recordings for appro priate indications, and data from the monitoring studies affected the management of patients with hypertension.