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Ambulatory blood pressure monitoring in treated hypertensive patients--implications for clinical practice
1Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario.
Insights
Many patients on long-term antihypertensive therapy may have white coat hypertension. A study found 40% of uncomplicated hypertensive patients could stop treatment without adverse effects, suggesting reduced unnecessary therapy.
Area of Science:
- Cardiology
- Hypertension Management
Background:
- White coat effect (WCE) is prevalent in patients on long-term antihypertensive therapy.
- WCE is more common in patients with higher office systolic blood pressure and in women.
Purpose of the Study:
- To investigate the potential for unnecessary antihypertensive therapy in community-based patients.
- To assess the feasibility of discontinuing treatment in uncomplicated hypertensive patients.
Main Methods:
- A study involving 98 uncomplicated hypertensive patients who had their antihypertensive treatment withdrawn for up to three years.
- Monitoring for re-development of hypertension and changes in left ventricular mass.
Main Results:
- At least 40% of patients remained normotensive after treatment withdrawal.
- No significant increase in left ventricular mass was observed in these patients.
Conclusions:
- A significant proportion of patients with uncomplicated hypertension may be over-treated.
- Ambulatory blood pressure monitoring is recommended to avoid misdiagnosis and unnecessary treatment.
Abstract:
Studies involving patients receiving longterm antihypertensive therapy have demonstrated a high prevalence of a white coat effect both in the tertiary care setting and in the community. The likelihood of finding a white coat effect is greater in patients with higher office systolic blood pressures and in women. The possibility that some hypertensive patients in the community may be receiving unnecessary therapy is currently being investigated in a study involving 98 uncomplicated hypertensive patients who have had treatment withdrawn for up to three years. To date, it appears that at least 40% of such patients may remain off treatment without re-developing hypertension or exhibiting any increase in left ventricular mass. Physicians should follow existing recommendations on the use of ambulatory blood pressure recording in order to avoid over-diagnosis and unnecessary treatment of hypertension.