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[Diagnosis of systemic hypertension: evidences that current criteria should be revised]
F D Fuchs1, J Lubianca Neto, R S Moraes
1Unidade de Farmacologia Clínica, Hospital de Clínicas de Porto Alegre, RS.
Insights
Diagnosing hypertension requires multiple blood pressure (BP) readings over several days. Initial high BP readings may decrease due to regression to the mean, potentially misclassifying patients.
Area of Science:
- Cardiology
- Clinical Pharmacology
Context:
- Hypertension diagnosis traditionally relies on averaged blood pressure (BP) readings.
- Lack of standardized guidelines for the number of BP readings needed for accurate hypertension diagnosis.
- Outpatient hypertension clinics require consistent methods for BP assessment.
Purpose:
- To describe the behavior of BP readings over three days in an outpatient hypertension clinic.
- To evaluate the impact of repeated BP measurements on hypertension classification.
- To inform diagnostic criteria for hypertension based on serial BP measurements.
Summary:
- Mean systolic (SBP) and diastolic (DBP) blood pressures decreased significantly from the first to the sixth reading.
- This decrease was primarily observed in patients with initially higher BP readings.
- Regression to the mean and patient reactivity are potential explanations for the observed BP reduction.
Impact:
- Findings support the need for multiple BP determinations, not a single reading, for hypertension diagnosis.
- Suggests that diagnosing severe hypertension based on the first two readings may lead to misclassification.
- Highlights the importance of standardized BP measurement protocols in clinical practice.
Unlabelled:
It has been recommended to take the average of several blood pressure (BP) determinations with a sphygmomanometer to diagnose hypertension, but there is no agreement on the reading numbers.
Purpose:
Describing the behavior of BP readings taken in three different days to establish the classificatory BP in an outpatient hypertension clinic.
Method:
In the outpatient hypertension clinic of the Clinical Pharmacology Division of the Hospital de Clínicas de Porto Alegre, we use the mean of six readings taken in three different days to establish the classificatory blood pressure, except for those with very high or low values in the first day. In this report we describe the behavior of BP in 58 patients submitted to this routine.
Results:
The mean of systolic (SBP) and diastolic (DBP) blood pressures decreased from the first to the 6th reading (ANOVA for repeated measurements: F = 4.45, P = 0.001 for SBP and F = 5.54, P < 0.001 for DBP). Afterward, the patients were classified into two groups according their first SBP and DBP reading. The decreasing in both SBP and DBP was confined to those with the first measurement in the upper half of the entire group (ANOVA: F = 8.03; P < 0.0001 for SBP and F = 6.33, P < 0.0001 for DBP). Regression to the mean and some reactiveness in the first day are possible explanations for this.
Conclusion:
These data corroborate that the hypertension diagnosis should not be based in an single blood pressure determination and suggest that the recommendation to diagnose severe hypertension based on high values in the first two readings could misclassify some patients.