Should we use ambulatory blood pressure monitoring to guide therapy?
- PDF / 215,700 Bytes
- 6 Pages / 636 x 816 pts Page_size
- 7 Downloads / 224 Views
Corresponding author Thomas G. Pickering, MD, DPhil Behavioral Cardiovascular Health and Hypertension Program, Columbia Presbyterian Medical Center, PH 9-946, 622 West 168th Street, New York, NY 10032, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2008, 2:274 –279 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2008 by Current Medicine Group LLC
Blood pressure (BP) measured exclusively in the office setting is no longer acceptable as a sole criterion for diagnosing and treating hypertension. Out-of-office measurements are needed. The limitations of office measurements are principally the result of the small number of readings and the white coat effect. Ambulatory BP monitoring (ABPM) is the gold standard for assessing an individual patient’s risk and hence the need for treatment. Patients who have a high nocturnal BP (nondippers) may be at high risk, and the dipping pattern may be normalized by drug treatment. In addition, it is important to assess that treatment is lowering BP for the full 24 hours (peak and trough effects). However, ABPM is not well suited to the repeated assessments that are needed for the evaluation of the response to treatment. For this, home monitoring is preferred and, by using morning and evening measurements, the effects of treatment on the trough and peak BP can be determined.
Introduction Despite the availability of many powerful drugs for treating hypertension and the proven benefits of treatment, the rates of blood pressure (BP) control throughout the world remain disappointing. Although much attention has been given to poor patient adherence with prescribed treatment, and more recently to therapeutic inertia on the part of physicians [1••], little attention has been placed on the limited accuracy of conventional BP measurement as a means of assessing the response to treatment as one of the reasons for the low rates of BP control. In clinical trials and clinical practice, the customary procedure has been to take two or three BP measurements in the clinic or office, at intervals of weeks or months, and to assume that these
are representative of the prevailing BP level (often referred to as the true BP). There are at least three methods of measuring BP in clinical practice: clinic or office measurement; home BP monitoring (HBPM) or self-monitoring; and 24-hour ambulatory BP monitoring (ABPM). Although clinic measurement remains the standard method, it is increasingly supplemented by the out-of-office techniques, and some of its limitations can be overcome by the use of automated recorders that can take multiple readings in the office setting. Because it is becoming increasingly clear that ambulatory and HBP measurements give better predictions of cardiovascular risk in individual patients [2•], a strong case can be made for the routine use of out-of-office monitoring for the initial diagnosis, decision to initiate treatment, and assessment of treatment effectiveness. This raises the question of whether we should continue to rely on clinic BP to guide antihype
Data Loading...
