New Algorithm for the Diagnosis of HypertensionCanadian Hypertension Education Program Recommendations (2005)

Division of Cardiology, Sunnybrook & Women's Health Sciences Centre, Toronto, Ontario, Canada.
American Journal of Hypertension (Impact Factor: 2.85). 11/2005; 18(10):1369-74. DOI: 10.1016/j.amjhyper.2005.04.024
Source: PubMed


Most national and international guidelines for diagnosing hypertension include 24-h ambulatory blood pressure monitoring (ABPM) and self (home) BP monitoring (SBPM) as optional methods for identifying hypertensive patients. However, none of the current guidelines have yet included ABPM or SBPM as fundamental tools for diagnosing hypertension, preferring instead to rely on conventional office readings recorded by mercury sphygmomanometry. During the past 10 years, clinical outcome studies have consistently reported 24-h ABPM and SBPM to be significantly better predictors of cardiovascular events compared with the office BP, even when recorded under "research conditions." Based on the available evidence, the Canadian Hypertension Education Program has now developed an algorithm for diagnosing hypertension that offers three options: 1) conventional office BP, 2) SBPM, or 3) 24-h ABPM. Out-of-office BP measurements are recommended, whenever feasible, to minimize both measurement error associated with mercury sphygmomanometry and the white coat effect experienced by some patients.

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    • "In addition, we examined whether the associations found would be similar for both sexes, as in several studies lack of social support has been found to be associated with hypertension or correlated with blood pressure levels to a different extent in women and men [6, 14]. A major strength of the current study is that blood pressure measurements were performed at the participants’ homes instead of the clinic, preventing the occurrence of the white-coat effect [15], which threatens the validity of resting blood pressure measurement. "
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    ABSTRACT: Evidence is accumulating for an association between psychosocial stress and elevated blood pressure. However, studies focusing on adaptive psychosocial factors are scarce. We examined the association between putatively adaptive psychosocial factors and home blood pressure in a population study in the Netherlands. Resting blood pressure was measured of 985 female and 777 male participants between 20 and 55 years of age in their home setting. Questionnaires assessing problem-focused coping (active coping), adaptive emotion-focused coping (positive reinterpretation) and social support were completed. When controlled for age, marital and socio-economic status, body mass index, parental history of hypertension, physical exercise, smoking, alcohol, coffee, and--in women--oral contraceptives, positive reinterpretation was associated with a lower prevalence of elevated home blood pressure (>or=140/90 mmHg): OR = 0.60, 95% CI = 0.40-0.88 (P = 0.009). Although all three psychosocial variables were associated with both systolic and diastolic blood pressure level, in multivariable analyses, only the associations between systolic blood pressure and positive reinterpretation (beta = -0.09, t = 3.25, P = 0.001) and active coping (beta = 0.07, t = 2.65, P = 0.008) remained significant. Independent of other factors, only positive reinterpretation of the situation appeared to be related to more favorable blood pressure levels.
    International Journal of Behavioral Medicine 05/2009; 16(3):212-8. DOI:10.1007/s12529-008-9019-z · 2.63 Impact Factor
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    ABSTRACT: We examined all-cause mortality within a primary care setting in patients with white coat hypertension or sustained hypertension in whom blood pressure (BP) monitoring was indicated. This prospective multicenter study of ambulatory BP monitoring included 48 family practices in the county of Oxfordshire, United Kingdom. Mortality was compared for patients having white coat hypertension (mean of 3 clinic BP readings >140/90 mm Hg and daytime ambulatory readings< or =135/85 mm Hg) and patients having sustained hypertension (mean of 3 clinic readings >140/90 mm Hg and daytime ambulatory readings >135/85 mm Hg). A routine primary care cohort consisting of 5,182 patients chosen to undergo ambulatory BP monitoring by their family physician was followed up for a median of 7.3 years (interquartile range, 5.8-8.9). There were 335 deaths (6.5%), corresponding to a mortality rate of 8.9 deaths (95% confidence interval [CI], 8.0-9.9) per 1,000 years of follow-up. Patients with white coat hypertension (n = 1,117) were more likely to be female and were on average younger than patients with sustained hypertension (n = 4,065). The unadjusted rate of all-cause mortality in patients with white coat hypertension was lower, at 4.4 deaths per 1,000 years of follow-up (95% CI, 3.1-6.0) than that in patients with sustained hypertension, at 10.2 deaths per 1,000 years of follow-up (95% CI, 9.1-11.4). This reduction in all-cause mortality was still clinically significant after adjustment for age, sex, smoking, use of antihypertensive medication, and practice-clustering effects (hazard ratio = 0.64; 95% CI, 0.42-0.97; P=.04). White coat hypertension (elevation of clinic BP only) confers significantly less risk of death than sustained hypertension (elevation of both clinic and ambulatory BPs). Trials are now needed to evaluate the risk reduction achievable in patients who have white coat hypertension and are receiving BP-lowering therapy.
    The Annals of Family Medicine 09/2008; 6(5):390-6. DOI:10.1370/afm.865 · 5.43 Impact Factor
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    ABSTRACT: RESUMO O controle adequado da pressão arterial é fundamen- tal para se obter maior redução do risco cardiovas- cular. A avaliação desse parâmetro por um registro prolongado e fora do ambiente de consultório pode ser uma estratégia a ser considerada. A monitori- zação ambulatorial de pressão arterial de 24 horas (MAPA) permite avaliar de modo amplo o risco cardiovascular e é melhor preditor de eventos cardio- vasculares que as medidas casuais ou de consultório. O principal fator que justifica o uso da MAPA, como método para verificação de controle terapêutico da hipertensão arterial, é a identificação do efeito do avental branco nos pacientes hipertensos, pois per- mitir a identificação dos pacientes de maior ou menor risco discriminados pela média pressórica sistólica em 24 horas. Igualmente, existem evidências de que esta ferramenta de auxílio no tratamento do paciente hipertenso permite adequar o melhor esquema tera- pêutico com custo-efetividade favorável. PALAVRAS-CHAVE Monitorização ambulatorial de pressão arterial, trata- mento. ABSTRACT The blood pressure control is the basis of a better re- duction in the cardiovascular risk profile. The measure- ment of this parameter outside the medical office and for longer periods must be considered. The 24-hour ambulatory blood pressure monitoring (ABPM) offers a unique opportunity to improve the evaluation of the cardiovascular risk, mainly because it has shown su- periority over casual measurements. The diagnosis of the white-coat effect using the 24- hour mean systolic blood pressure allows the distinction between those patients with high or low cardiovascular risk. There are some evidences that this tool can be used to the- rapeutic control with cost-effectiveness.
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