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Hypertension

Hypertension- Role of Ambulatory BP and Home BP Monitoring

There is no prospective trial that has compared treatment guided by repeated measures of ambulatory BP versus conventional therapy guided by office BP measurements.

I suggest that just as with ambulatory BP monitoring, to not rely on home BP monitoring in all patients. The overall risk of the patient should be determined,

  • low risk patients may be reassured if home BP measurments or ambulatory BP measurements are good. However, the cost-effectiveness of more widespread use of ambulatory BP monitoring is not proven. If home BP monitoring can be done more cheaply then more widespread use may be cost-effective.
  • when one is about to add second or third line agents that are much more expensive than simple betablockers or thiazide diuretics, then it is much more likely that prudent use of ambulatory blood pressure monitoring will be cost-effective, on the basis that it will help identify a significant proportion with white-coat hypertension that do not need more expensive additional therapy.
  • high risk patients may well obtain significant absolute benefit from treatment even if home BP measurements suggest presence of "white-coat hypertension".
  • ambulatory blood pressure monitoring may identify a group of patients referred to as having masked hypertension, ie those whose blood pressure is higher on ambulatory of home BP monitoring than random measurements in the office. Those with masked hypertension seem to have a higher risk of future events than those with white-coat hypertension.
  • high risk patients on multiagent therapy and whose blood pressure has been reduced significantly may sometimes still have high office blood pressure. It seems reasonable in this situation to be guided by measurement of out of office blood pressure to determine the need for addition of even more anti-hypertensive therapy.

This section is under active revision. Over time, additional information will be added under the following sub-headings.

  • Selected data in white-coat hypertension
    • on estimation of risk of future events
  • Selected data in treated hypertension
    • on estimation of risk of future events before treatment
    • on usefulness of ambulatory BP measurements during treatment
      • OVA Study
      • SAMPLE Study- on prediction of LVH regression
      • on differential predictive value of pulse pressure and mean blood pressure
      • on impact of morning surge of blood pressure on stroke risk
    • on usefulness of home BP measurements before treatment
  • Date correlating findings of ambulatory BP monitoring with LVH, carotid intimal media thickness and other measurements that are likely to be related to severity of hypertension.
  • Data suggesting little additional benefit from Ambulatory BP monitoring

Hitesh Patel, Cardiologist
Revised 25th September, 2005

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