Do you know what form of hypertension you have?

The authors aimed to evaluate the use of 24-hour ambulatory blood pressure measurements in blood pressure management.

Hypertension (high blood pressure) is a major risk factor for cardiovascular diseases. While blood pressure (BP) can be measured in the doctor’s office (office BP), it is suggested that a noninvasive method of obtaining blood pressure readings over twenty-four hours, while the patient is in their own environment, representing a true reflection of their blood pressure (24-hour ambulatory BP) may be more useful in establishing the form of hypertension present. Identifying the form of hypertension can help guide treatment goals.

The study evaluated 4,078 hypertensive patients with uncontrolled office BP (>140/90 mm Hg). Therapy to lower blood pressure (with at least 3 different types of drugs) was intensified and after 1 year, both office BP and 24-hour ambulatory BP were measured.

After 1 year, 50.5% of the patients had a controlled office BP (<140/90 mm Hg). However, of these patients, 65.8% had 24-hour ambulatory BP of ≥130/80 mm Hg, indicating masked hypertension (32.9% of all treated patients). Masked hypertension is when office BP is normal, but is uncontrolled or abnormal in daily life, leading to inadequate treatment. Thus, overall approximately 1 out of 3 treated hypertensive patients and 2 out of 3 patients with apparently controlled office BP had masked hypertension.

White-coat hypertension is where a patient’s feeling of anxiety in a medical environment results in an abnormally high BP reading in the doctors office, and was defined as an office BP of ≥140/90 mm Hg but a 24-hour ambulatory BP of <130/80 mm Hg. This was found in 12.4% of those who had elevated BP in the doctor’s office (6.1% of all patients). Thus, 1 out of 8 treated hypertensive patients had white-coat hypertension, potentially resulting in overtreatment.

The authors concluded that both 24-hour ambulatory BP monitoring and office BP are crucial to avoid the wrong classification of those with hypertension and to guide treatment decisions.

The majority of patients were on the drug aliskiren (Tekturna), which may have introduced bias into the results.

When establishing BP treatment goals, consult with your doctor on the optimal BP monitoring regimen.