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Blood Pressure Out of the Office: Its Time Has Finally Come
1Icahn School of Medicine at Mount Sinai, New York, New York, USA. Lawrence.krakoff@mountsinai.org.
Insights
Out-of-office blood pressure monitoring, including 24-hour ambulatory monitoring and home blood pressure monitoring, is crucial for diagnosing hypertension. These methods help identify white coat hypertension and masked hypertension, improving patient care.
Area of Science:
- Cardiology
- Hypertension Research
- Medical Diagnostics
Background:
- Historical differences between office and out-of-office blood pressure readings were noted in the 1930s.
- Hypertension diagnosis and treatment evolved significantly from the 1950s with epidemiological links to cardiovascular disease and effective drug development.
- Technological advancements enabled portable, noninvasive blood pressure monitoring devices.
Purpose of the Study:
- To highlight the evolution and increasing importance of out-of-office blood pressure measurement in hypertension diagnosis.
- To underscore the role of modern monitoring techniques in identifying specific hypertension subtypes.
- To establish out-of-office blood pressure measurement as the emerging standard of care.
Main Methods:
- Utilizing 24-hour ambulatory blood pressure monitoring.
- Employing home blood pressure monitoring (HBPM).
- Comparing out-of-office readings with traditional in-office measurements.
Main Results:
- Recognition of white coat hypertension (WCH) and masked hypertension (MH) is facilitated by out-of-office measurements.
- Accurate "real-life" blood pressure assessment is now feasible and necessary.
- Out-of-office monitoring provides a more comprehensive understanding of a patient's blood pressure profile.
Conclusions:
- Out-of-office blood pressure measurement is essential for accurate hypertension diagnosis and management.
- These methods are critical for identifying and addressing conditions like WCH and MH.
- Out-of-office blood pressure monitoring is becoming the standard of care in hypertension management.
Abstract:
The diagnosis of hypertension includes measurement of blood pressure out of the office by either 24-hour ambulatory monitoring or home blood pressure monitoring. These methods have led to recognition of "white coat hypertension" (WCH) and "masked hypertension" (MH). Research in the 1930s first demonstrated that blood pressures in the office were often far different from those out of the office, at a time when there was no effective treatment. International attention was focused on another imminent world war and a highly controversial election in the United States. Hypertension was not a priority for concern. From the 1950s onward: (i) epidemiology linked hypertension to risk of cardiovascular disease, (ii) effective and safe drugs for treatment of hypertension appeared, (iii) randomized clinical trials demonstrated that drug treatment of hypertension is highly effective for prevention of cardiovascular disease, and (iv) advances in technology led to development of small, portable devices for recording blood pressure noninvasively at home or during usual activities. Accurate measurement of blood pressure in "real life" is now necessary and feasible for appropriate diagnosis and assessment of treatment. Out-of-office blood pressure measurement is emerging as the standard of care for hypertension.
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