Patient-Oriented Evidence That Matters
Ambulatory Blood Pressure Important for Decision-Making About Treatment
Am Fam Physician. 2018 Oct 15;98(8):online.
What is a better predictor of mortality: ambulatory or office-based measurement of blood pressure?
This study supports the guidelines recommending that treatment decisions be based on ambulatory blood pressure measurements rather than in-office blood pressure results. The difference between the two measurements in this cohort was 19/11 mm Hg, which is enough to change the decision to prescribe a medication at all, or to add a second or third medication. (Level of Evidence = 2b)
How we measure things matters. For example, nonfasting lipid levels are a better predictor of mortality than fasting lipid levels. Recent guidelines for hypertension, including those from the U.S. Preventive Services Task Force, have emphasized the need to confirm elevated blood pressure in most patients using some form of ambulatory blood pressure monitoring. This study used data from a large Spanish hypertension registry to look at the association between clinic blood pressure, ambulatory blood pressure, and mortality. The registry includes adults with an indication for ambulatory blood pressure monitoring, such as suspected white coat hypertension, borderline or labile hypertension, or hypertension refractory to treatment. The registry supplies data on clinic blood pressure, measured by automated devices after five minutes of seated rest, and 24-hour ambulatory blood pressure measurements. These data were linked to national vital statistics databases to determine cardiovascular and all-cause mortality. The analysis was adjusted for comorbidities, age, sex, tobacco use, and body mass index. The mean age of patients was 58 years, 58% were male, and only 11% had a diagnosis of cardiovascular disease. During a median 4.7 years of follow-up, there were a total of 3,808 deaths, including 1,295 cardiovascular deaths. The mean ambulatory blood pressure was 129/76 mm Hg, compared with 148/87 mm Hg in the clinic. The clinic blood pressure was measured by an automated
POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.
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