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Assessment of appropriate utilization of out-of-office diagnostic tools for the diagnosis of hypertension
Hussam Jnaid1, Mohammed Aldosari1, Mohammad Waqar Ahmad1
1Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Saudi Arabia.
Insights
Out-of-office blood pressure (BP) monitoring, including ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), is underutilized in newly diagnosed hypertension patients. Adherence to American Heart Association guidelines for ABPM use needs improvement, especially in older adults and those with comorbidities.
Area of Science:
- Cardiology
- Hypertension Management
- Diagnostic Tools
Background:
- Out-of-office blood pressure (BP) measurement devices like ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) improve diagnostic accuracy.
- The American Heart Association (AHA) recommends ABPM for confirming hypertension diagnoses to prevent overdiagnosis.
- Accurate BP readings are crucial for effective hypertension management and detecting conditions like white-coat and masked hypertension.
Purpose of the Study:
- To determine the prevalence of ABPM and HBPM use before hypertension diagnosis.
- To evaluate adherence to AHA recommendations for ABPM utilization.
- To investigate how patient characteristics influence out-of-office BP monitoring practices.
Main Methods:
- A retrospective cross-sectional study design was employed.
- Data were collected from adult patients newly diagnosed with essential hypertension.
- The study was conducted at a primary care center in Riyadh, Saudi Arabia, between 2016 and 2022.
Main Results:
- Ambulatory BP monitoring (ABPM) orders were issued for 57.8% of patients, but only 48.5% completed the procedure.
- Hypertension diagnoses were based solely on ABPM in 42.2% of cases, with home BP monitoring (HBPM) used in 7.1% alone and 1.1% in combination.
- ABPM use was lower in older adults, individuals with diabetes or chronic kidney disease, and married patients, though these associations were not significant in the fully adjusted model.
Conclusions:
- Out-of-office BP monitoring, especially ABPM, is underutilized in newly diagnosed hypertensive patients.
- Underutilization is noted in older patients and those with comorbidities who could benefit most from these methods.
- Physician awareness and adherence to current guidelines for out-of-office BP monitoring require enhancement.
Background:
Out-of-office blood pressure (BP) measurement devices, such as ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), enhance the accuracy and reliability of BP readings, detecting white-coat and masked hypertension. The American Heart Association (AHA) advises confirming hypertension diagnoses with ABPM to prevent overdiagnosis, emphasizing the importance of precise out-of-office diagnostic tools. This study aimed to 1) explore the prevalence of ABPM and HBPM use prior to hypertension diagnosis; 2) assess the adherence to AHA recommendations regarding ABPM utilization; and 3) investigate the association between patient characteristics and out-of-office BP monitoring practices.
Methods:
A retrospective cross-sectional study analyzed a random sample of adult patients newly diagnosed with essential hypertension at a tertiary hospital primary care center in Riyadh, Saudi Arabia, between 2016 and 2022.
Results:
This study evaluated the use of ABPM and HBPM in a sample of 268 newly diagnosed hypertensive patients, with a mean age of 49.17 ± 12.69 years. Although ABPM orders were placed for 57.8% of patients, only 48.5% completed the procedure. Notably, 42.2% of hypertension diagnoses were solely based on ABPM, while 7.1% and 1.1% utilized HBPM alone or in combination with ABPM, respectively. This analysis revealed a lower utilization of ABPM among older adults, individuals with diabetes or chronic kidney disease, and married patients (P < 0.05). However, this association with marital status, diabetes, and chronic kidney disease was no longer statistically significant in a fully adjusted model (P > 0.05).
Conclusion:
Out-of-office BP monitoring, particularly ABPM, was underutilized in newly diagnosed hypertensive patients, especially in older age groups and patients with specific comorbidities, who may benefit the most from this method. These results underscore the need for increasing physician knowledge and compliance with the existing guidelines.
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