2017.04.04 14:15
In a primary care setting, automated office blood pressure monitoring during 30 minutes (OBP30) yields considerably lower blood pressure readings than routine office blood pressure (OBP) readings, a recent study found. The study included 201 patients (mean age 68.9 years, 56.7% women) who were referred for OBP30 due to concern about white-coat hypertension. OBP30 is performed with the patient sitting alone for 30 minutes while the blood pressure is measured automatically every 5 minutes, for a total of 7 readings, and the OBP30 is the average of the last 6 BP readings. This has been shown to correlate well with ambulatory blood pressures. The authors compared OBP30 with routine OBP readings and evaluated how OBP30 influenced medication prescribing. Researchers found:
Citation:
Bos MJ, Buis S. Thirty-minute office blood pressure monitoring in primary care. Ann Fam Med. 2017;15:120-123. doi:10.1370/afm.2041.
Commentary:
The difference of over 20 mm Hg in systolic BP between routine BP readings causes pause. Approximately 15% of patients with elevated office blood pressures have white-coat hypertension, meaning their blood pressures outside of the office are not elevated. Identifying this group is important, but often challenging. Currently, the easiest and most common method used to identify white-coat hypertension is to ask patients to purchase a home blood pressure monitor and record their blood pressures, morning and later in the day, at home and to bring those values to their next office visit. Alternatively, ambulatory 24-hour blood pressure monitoring can be ordered. This study shows that in selected patients for whom a concern of white-coat hypertension exists, 30-Minute Office BP Monitoring is another way to identify white-coat hypertension and can substantially influence decisions about treatment in a large number of patients. —Neil Skolnik, MD
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This simple study shows how much fluctuation there is in BP
especially in the elderly whose arteries are stiff and less stretchable
and less elastic so that any little stress, physical or mental, that
increases catecholamines such as adrenaline can immediately
elevate the blood pressure(which is equal to cardiac output x vascular resistance).
I cannot overemphasize the importance of close monitoring of BP in the elderly.
It was not uncommon for me to take BP on my patient more than 5 or 6 times
during their office visit. I usually keep taking BP as long as the BP is coming down
and stop when it finally settles somewhere.