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| |  ASH: Home Blood Pressure Monitoring May Provide More Accurate Assessment of Overall Blood Pressure By Jill Stein Special to DG News
SAN FRANCISCO, CA -- May 17, 2001 -- Home blood pressure monitoring predicts ambulatory blood pressure in patients with white coat hypertension, better than does office blood pressure monitoring. This finding was presented at the 16th Annual Scientific Meeting of the American Society of Hypertension (ASH). As part of a prospective study on the usefulness of trans-telephonic self-blood pressure management, Dr. William White and colleagues with the University of Connecticut School of Medicine in Farmington compared home blood pressure in subjects with high office but normal ambulatory blood pressure (white coat hypertension) and subjects with elevated office and awake blood pressure (sustained hypertension). The trial included 32 untreated subjects with office pressures above 140 mm Hg and/or 90 mm Hg and compared ambulatory and home blood pressure methods. All patients were studied using an ambulatory monitor for 24 hours. Patients performed at least five days of trans-telephonic home blood pressure monitoring. Patients with an awake systolic blood pressure less than 130 mm Hg and a diastolic pressure less than 80 mm Hg were considered white coat hypertensives. "If home self -monitoring can assist the health care provider in identifying patients with white coat hypertension, then immediate treatment may be avoided," Dr. White said. "However, unless home blood pressure is directly compared to ambulatory blood pressure, major errors in diagnosis and treatment can be made." In the present study, both home systolic and diastolic blood pressure correlated strongly with the corresponding awake blood pressure, Dr. White reported. The office-awake systolic blood pressure difference correlated strongly with the office-home systolic blood pressure difference and with the diastolic blood pressure differences. Overall, the results showed that home blood pressure is significantly lower in patients with white coat hypertension than in patients with sustained hypertension, Dr. White said. The finding that home blood pressure also correlated strongly with ambulatory blood pressure but not office blood pressure suggests that home blood pressure is superior to office readings for estimating overall blood pressure, he added. Self-monitoring of blood pressure has become an integral part of clinical practice. In fact, various studies show that 25 to 75 percent of all patients with hypertension perform self-monitoring of blood pressure. Several factors account for the recent explosive increase in self- monitoring of blood pressure, including increased awareness of hypertension, increased awareness of hypertension as a major cardiovascular risk factor, increased patient autonomy in health decisions, and the widespread availability of cheap, accurate, simple electronic devices to measure blood pressure. Another factor is the recognition by health care providers of the usefulness of self- monitoring in reducing costs, increasing adherence to treatment, and improving blood pressure control. Recent guidelines identified several areas of self-monitoring of blood pressure that require further study. These include a universal validation protocol for self- monitoring devices, the development of an adjustable cuff for all adults, and the determination of reference values.
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