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[Decisions and therapeutic attitudes for patients with white coat hypertension]
E Vinyoles Bargalló1, A Garaikoetxea Iturriria, M Ibernón López
1Medicina de Familia, Centro de Atención Primaria Universitario La Mina, San Adrián del Besós, Barcelona.
Insights
Ambulatory blood pressure monitoring (ABPM) likely leads to a delayed start of pharmacologic treatment for white coat hypertension (WCH) compared to arterial hypertension (AH). This conservative approach may impact patient outcomes.
Area of Science:
- Cardiology
- Hypertension Management
- Diagnostic Tools
Context:
- Arterial hypertension (AH) and white coat hypertension (WCH) require distinct therapeutic strategies.
- Accurate differentiation between AH and WCH is crucial for effective patient management.
- 24-hour ambulatory blood pressure monitoring (ABPM) is a key diagnostic tool.
Purpose:
- To compare therapeutic attitudes and treatment delays in patients with AH versus WCH.
- To analyze the impact of ABPM findings on clinical decision-making.
- To investigate the relationship between hypertension type and target organ involvement.
Summary:
- A retrospective study analyzed 86 untreated patients with poor blood pressure control using 24-hour ABPM.
- 43 patients were diagnosed with WCH and 43 with AH; treatment initiation was significantly delayed in the WCH group (19 months vs. 1.2 months).
- Patients with AH showed more target organ involvement by the study's end.
Impact:
- ABPM findings may contribute to a more conservative initial pharmacologic treatment approach.
- Delayed treatment in WCH patients warrants further investigation regarding long-term consequences.
- This study highlights the importance of timely and appropriate hypertension management based on accurate diagnosis.
Objective:
To analyze the different therapeutic attitudes towards patients with arterial hypertension (AH) or white coat hypertension (WCH).
Design:
Longitudinal, retrospective study after performing a 24 h ambulatory blood pressure monitoring of ABPM.
Setting:
Urban health center.
Patients:
Eighty-six patients aged over 15 years, not treated and with figures of a poor blood pressure control (> 140 and/or > 90 mmHg), followed for a mean of four years.
Intervention:
Initial 24-h ABPM (SpaceLabs 90202-90207). DETERMINATIONS AND MAIN RESULTS: After ABPM 43 patients were classified as having WCH and 43 patients AH. Both groups were comparable. Pharmacologic treatment was begun from 41.9% (n = 18) of WCH and 88.4% (n = 38) of AH (p < 0.001) patients with a delay, after ABPM, of 19 months (SD 22) and 1.2 months (SD 3.2), respectively (p < 0.01). At the end of the follow-up period patients with AH had more target organs involved.
Conclusions:
The information provided by ABPM probably entails a more conservative approach at the beginning of pharmacologic treatment.