24-hour monitoring of blood pressure

Date: Nov, 1990

24-Hour Monitoring of Blood Pressure Up to 30 percent of patients with elevated blood pressure in the physician's office may have normal readings in other settings. Long-term follow-up evaluations confirm that end-organ damage is more closely correlated with ambulatory blood pressure measurements than with conventional office measurements.

Two methods of obtaining ambulatory recordings are 24-hour monitoring and intermittent measurements. Rucker and colleagues studied treatment decisions by physicians to determine whether the type of monitoring used influenced the selection of treatment strategies.

Records of 17 patients were evaluated by 11 physicians. The physicians based their treatment decisions, in a stepwise fashion, on the following information: (1) office recordings alone> (2) office blood pressure and intermittent measurements at 9 a.m., 12 noon, 5 p.m. and 10 p.m. (abstracted from the 24-hour measurements), and (3) office blood pressure and 24-hour blood pressure monitoring. The physicians were asked to assume that all of the measurements were obtained from an asymptomatic 45-year-old man with no cardiac risk factors.

In 14 "cases," the physicians were not able to make a treatment decision, leaving 173 "cases" for analysis. The addition of either continuous or intermittent monitoring to office recordings significantly altered treatment decisions. Physicians arrived at the same treatmnt decisions with the addition of intermittent or continuous monitoring.

The authors conclude that the simpler and less expensive technique of intermittent blood pressure monitoring could be substituted for 24-hour monitoring in the evaluation of patients with elevated blood pressure readings. (Southern Medical Journal, June 1990, vol. 83, p. 610.)

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