Related Experiment Videos
Ambulatory blood pressure monitoring: guidelines for use in clinical practice
1Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario.
Insights
Ambulatory blood pressure monitoring (ABPM) is crucial for diagnosing hypertension in Canada. A revised algorithm, considering the
Area of Science:
- Cardiology
- Hypertension Management
- Diagnostic Tools
Background:
- Ambulatory blood pressure monitoring (ABPM) is increasingly vital for hypertensive patient diagnosis and management, especially in Canadian urban centers.
- Existing guidelines for ABPM indications exist, including an algorithm from the American Society of Hypertension for diagnosing persistent hypertension.
- The concept of 'white coat' hypertension and its implications for cardiovascular outcomes require careful consideration in clinical practice.
Purpose of the Study:
- To propose a revised algorithm for implementing ABPM in hypertension diagnosis, tailored to the Canadian healthcare setting.
- To discuss concerns surrounding 'white coat' hypertension and introduce the 'white coat effect' concept for both treated and untreated patients.
- To provide a practical framework for utilizing ABPM in Canadian clinical practice based on existing recommendations.
Main Methods:
- Review and adaptation of the American Society of Hypertension's algorithm for ABPM use.
- Analysis of the concept of 'white coat' hypertension and its clinical relevance.
- Consideration of preliminary evidence regarding cardiovascular outcomes in patients with 'white coat' effects.
Main Results:
- A revised algorithm for ABPM implementation in Canadian hypertension diagnosis is proposed.
- The 'white coat effect' is presented as a relevant factor in both untreated and treated hypertensive patients.
- Preliminary data suggest patients with a 'white coat' component may have better cardiovascular outcomes than those with persistent ambulatory hypertension.
Conclusions:
- The proposed revised algorithm offers a practical approach to ABPM use in Canadian hypertension diagnosis.
- Understanding the 'white coat effect' is important for accurate hypertension management.
- ABPM, guided by appropriate algorithms, is a valuable tool for Canadian clinicians managing hypertensive patients.
Abstract:
Ambulatory blood pressure monitoring is rapidly becoming an integral part of the diagnosis and management of hypertensive patients, particularly in major urban Canadian centres. To date, there have been several attempts to define the indications for ambulatory blood pressure monitoring, the most recent coming from an ad hoc panel of the American Society of Hypertension. This panel developed an algorithm for diagnosing persistent hypertension using office, home and ambulatory blood pressure readings. A revised algorithm tailored to the Canadian health care setting is proposed for implementing ambulatory blood pressure monitoring in the diagnosis of hypertension. Concerns about the term 'white coat' hypertension are discussed and the concept of a white coat effect for both untreated and treated patients is presented. There is preliminary evidence that patients who have a white coat component to their office readings experience fewer cardiovascular outcomes than do those with more persistent ambulatory hypertension. Recommendations from the ad hoc committee of the American Society of Hypertension provide a practical basis for using ambulatory blood pressure monitoring in clinical practice in Canada.