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Management of Hypertension after Ambulatory Blood Pressure Monitoring

Jennifer M. Grin, BS; Ellen J. McCabe, RN; and William B. White, MD
[+] Article, Author, and Disclosure Information

From the University of Connecticut School of Medicine, Farmington, Connecticut. Requests for Reprints: William B. White, MD, Section of Hypertension and Vascular Diseases, University of Connecticut Health Center, Mail Code 3940, Farmington, CT 06032.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;118(11):833-837. doi:10.7326/0003-4819-118-11-199306010-00001
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Objective: To study the test-ordering behavior of practicing physicians regarding ambulatory monitoring of blood pressure and to assess changes in patient management after this study.

Design: Cross-sectional assessment of physicians' practice habits regarding the ordering of ambulatory blood pressure monitoring and a longitudinal study of patient management after monitoring.

Setting: Physicians' offices in central Connecticut.

Participants: Two hundred thirty-seven consecutive patients referred by 65 community- and hospital-based physicians.

Measurements: Indications for ambulatory blood pressure monitoring, changes in diagnosis and therapy, and office blood pressures before and after the ambulatory blood pressure study.

Results: The main indications for ordering the test included borderline hypertension (27% of studies ordered), assessment of blood pressure control during drug therapy (25%), evaluation for white coat or office hypertension (22%), and drug-resistant hypertension (16%). After the ambulatory blood pressure study, only 13% of the patients had further testing (for example, echocardiography); the diagnosis was changed in 41% of the patients, and antihypertensive therapy was changed in 46%. In 122 patients for whom data were complete, office blood pressure measured by the referring physician decreased from 161/96 22/12 mm Hg before the ambulatory blood pressure study to 151/86 27/12 mm Hg 3 months after the study (P = 0.004 for systolic blood pressure and P < 0.001 for diastolic blood pressure). One to 2 years after the study, office blood pressure was 149/86 24/12 mm Hg (P > 0.2 compared with 3 months after the study). Seventy-two percent of the patients had a lower office blood pressure within 3 months of the ambulatory blood pressure study.

Conclusions: Practicing physicians use ambulatory blood pressure recordings for appropriate indications, and data from the monitoring studies affected the management of patients with hypertension.


Grahic Jump Location
Figure 1.
Number of referring physicians according to clinical specialty.

Community-based physicians were defined as practitioners with private office practices; hospital-based physicians were defined as full-time hospital employees with clinics or office practices in a community or teaching hospital.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Clinical indications for patient referral for ambulatory blood pressure monitoring.

No statistical differences were observed between types of referrals from community-based and hospital-based physicians.

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Grahic Jump Location
Figure 3.
Office blood pressure measurements obtained by referring physicians before ambulatory blood pressure monitoring in 237 patients.
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Grahic Jump Location
Figure 4.
Distribution of changes in office blood pressure measurements within 3 months after ambulatory blood pressure monitoring relative to prestudy measurements.
Grahic Jump Location




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