The use of ambulatory blood pressure monitoring in managing hypertension according to different treatment guidelines

Objective: To investigate the use of ambulatory blood pressure monitoring ( ABPM) in identifying and managing a group of patients referred to a tertiar y centre for the assessment of their blood pressure and to illustrate the i mportance of introducing standardised ABPM treatment guidelines. Patients and methods: We examined 2000 sequential ABP recordings, 1557 Were first time referrals from General Practitioners, Consultants and other hos pitals. All patients were referred with suspected hypertension, resistant h ypertension, white coat hypertension and for investigations of secondary hy pertension. Fully trained nurse specialists fitted the monitors in the hype rtension clinic and recordings were performed for 24 h. The data was then a nalysed and stratified according to treatment guidelines and categorised ac cording to different definitions. Results: The group of first time referrals (n = 1557) showed an even sex di stribution of 789 men and 768 women, mean age 53 +/- 13.8 (12-88 years). Of this group 542 patients (35%) exhibited a white coat effect (WCE), 526 (34 %) had a daytime ABP less than or equal to 139/89 mm Hg. Of these 81 (15%) had a high clinic blood pressure (ie, white coat hypertension (WCH)) accord ing to our definition. Thirty-five of these patients were not on treatment but may have had it initiated on the basis of their clinic pressures. Accor ding to the British Hypertension Society (BHS) guidelines on clinic reading s 772 (45%) of our patients would be classified as hypertensive or inadequa tely treated, 509 (33%) borderline and 326 (21%) as normal. Using daytime A BP levels according to O'Brien: 1031 (67%) would be defined as abnormal, 19 2 (12%) as borderline and 334 (21%) as normal. Conclusion: These results illustrates how patient management may differ mar kedly when treating in accordance either with the BHS guidelines for clinic readings or the suggested levels for ABP. More patients had abnormal blood pressure levels according to ABPM, even though it is superior in detecting WCE and WCH. Clear guidelines for ABPM treatment levels need to be establi shed.