C. Addison et al., The use of ambulatory blood pressure monitoring in managing hypertension according to different treatment guidelines, J HUM HYPER, 15(8), 2001, pp. 535-538
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.