A practical approach to persistent elevation of blood pressure in the hypertension clinic

Area of Science:

• Cardiology
• Hypertension Management
• Clinical Diagnostics

Background:

• Persistent elevation of office blood pressure (BP) is a common challenge in hypertension clinics.
• Patients often present with difficulties in achieving BP goals, necessitating specialist evaluation.
• Home and ambulatory BP monitoring data are frequently available in this setting.

Purpose of the Study:

• To propose a systematic scheme for hypertension specialists to evaluate persistent elevation of office BP.
• To guide the differentiation of true hypertension from other causes of elevated office readings.
• To encourage a conscious consideration of underlying reasons for sustained high BP.

Main Methods:

• Initial consideration of falsely elevated office BP readings due to pseudohypertension or equipment issues.
• Distinguishing between transient office BP elevation with normal out-of-office readings (white-coat hypertension) and sustained elevation.
• Evaluating patients with consistently elevated office and out-of-office readings for sustained hypertension and secondary causes.

Main Results:

• The proposed scheme categorizes persistent high office BP into potentially artifactual, transient (white-coat), or sustained hypertension.
• Sustained hypertension, often the majority, requires further investigation for secondary causes.
• The intensity of secondary hypertension evaluation should be tailored to the patient's clinical presentation.

Conclusions:

• A structured approach is recommended for evaluating persistent high office BP in hypertension clinics.
• Differentiating white-coat hypertension from sustained hypertension is crucial for appropriate management.
• Systematic consideration of secondary hypertension causes is essential for patients with persistently elevated BP readings.