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Twenty-four hour ambulatory blood pressure monitoring in general practice
T Rugnath1, B J Pillay, M H Cassimjee
1Department of Medically Applied Psychology, University of Natal, Durban.
Insights
Ambulatory blood pressure monitoring (ABPM) is crucial for diagnosing hypertension. Many patients diagnosed with hypertension via casual readings actually have white coat hypertension, which ABPM can help differentiate.
Area of Science:
- Cardiology
- General Practice
- Diagnostic Medicine
Background:
- Hypertension diagnosis traditionally relies on casual office blood pressure (BP) readings.
- Ambulatory blood pressure monitoring (ABPM) reveals that some patients diagnosed with hypertension may not actually have the condition.
- White coat hypertension, where BP is elevated in a clinical setting but normal otherwise, is a recognized phenomenon.
Purpose of the Study:
- To evaluate the utility of ambulatory blood pressure monitoring (ABPM) in diagnosing hypertension within general practice settings.
- To assess the prevalence of white coat hypertension in patients with mild to moderate hypertension diagnosed by casual BP measurements.
- To compare characteristics of white coat hypertensives with true hypertensives and analyze correlations between casual and ABPM readings.
Main Methods:
- Sixty-four Indian patients with mild to moderate hypertension (diagnosed via casual BP) underwent 24-hour ABPM.
- Hypertension classification was based on BP load: >35% for true hypertension, <35% for white coat hypertension.
- Demographic data and correlations between casual and ABPM readings were analyzed.
Main Results:
- A prevalence of 23.44% for white coat hypertension was identified.
- White coat hypertensives were predominantly non-obese females (73.33%), often on medication (60%).
- A weak correlation was observed between casual and 24-hour ABPM readings in the white coat hypertension group.
Conclusions:
- White coat hypertension is prevalent in patients diagnosed with mild to moderate hypertension using casual BP readings.
- Reliable clinical indicators for identifying white coat hypertension are lacking.
- ABPM is an effective tool for distinguishing between white coat hypertension and true hypertension.
Objectives:
To assess the role of ambulatory blood pressure (BP) monitoring in the diagnosis of hypertension in general practice.
Background:
Hypertension is usually diagnosed by means of casual office BP readings. However, ambulatory BP monitoring has shown that a significant proportion of patients diagnosed as hypertensive do not in fact have hypertension.
Method:
Sixty-four Indian patients diagnosed as having mild to moderate hypertension by means of casual measurements were subjected to 24-hour ambulatory blood pressure monitoring (ABPM). A BP load of > 35% was classified as true hypertension and < 35% as 'white coat' hypertension. White coat hypertensives were compared with the true hypertensive group with regard to various demographic characteristics, as well as to correlate ABPM and casual BP readings.
Results:
A 23.44% prevalence of white coat hypertension was found. In addition, the demographic profile of such patients showed a preponderance of non-obese females (73.33%), the majority of whom were on concomitant medication (60%). A poor correlation was found between the casual office BP readings and the 24-hour ambulatory BP readings in the white coat hypertensive group compared with the true hypertensive group.
Conclusion:
White coat hypertension is common in patients diagnosed as having mild to moderate hypertension by means of casual BP readings. There are no reliable clinical indicators to identify patients with white coat hypertension. ABPM has been shown to be a useful method for differentiating white coat hypertensive groups from true hypertensive groups.