| Until quite recently,
doctors have relied almost exclusively on blood pressure readings taken
in their offices for evaluating patients with hypertension. Two other
techniques (ambulatory and self monitoring) are becoming increasingly
popular, and this report, produced by a panel appointed by the American
Society of Hypertension, makes recommendations about their use.
Ambulatory monitoring involves wearing a portable
monitor for 24 hours, and is recommended for diagnosing white coat
hypertension, and certain other conditions in which the clinic or office
measurements may thought to be misleading.
Self monitoring is recommended for the majority of
hypertensive patients. It has several potential advantages: it may be
helpful in diagnosing white coat hypertension, it can be used for
assessing the response to treatment, it may improve compliance in taking
mediations, and it may save costs. There are, however, some patients in
whom it may not be suitable, either for technical reasons (a very obese
arm, or irregular heart beats, for example), or because it makes the
patient more anxious.
It is important that a properly validated device
is used, and that the patient's technique be checked. Blood pressure
readings should be taken at different times of the day (usually morning
and evening). The frequency of readings depends on the situation: for
initial evaluation it may be appropriate to take them several days per
week, but when the patient's condition is diagnosed and stable readings
can be taken less frequently.
Doctor's comments
The medical profession has been slow to recognize
the value of blood pressure readings taken outside the doctor's office,
and third party payers do not often reimburse for the costs of either
ambulatory or self-monitoring. The use of self monitoring has also been
endorsed by the American College of Physicians and the Joint National
Committee on Detection, Evaluation, and Treatment of high blood
pressure, although neither organization gave recommendations as detailed
as these.
Where it was published
Pickering, Dr. Thomas for an American Society of
Hypertension ad hoc panel. Recommendations for the use of home (self)
and ambulatory blood pressure monitoring. American Journal of
Hypertension 1996;9:1-11. |