A program that combined automated office BP/home BP measurement detected ‘white-coat’ BP elevation and reduced unnecessary antihypertensive therapy, according to findings recently published in the Journal of the American Board of Family Medicine.
“I have worked as a primary care physician for almost 20 years and have frequently heard patients complain that the BP number we got in clinic seemed too high, or that they were rushed to have their BP collected right after walking into clinic,” Molly B. Conroy, MD, MPH, School of Medicine, University of Utah, said in an interview.
“When I was working at the University of Pittsburgh, I was the site principal investigator of the SPRINT study. The results from SPRINT were a driving force in new BP guidelines. Seeing the contrast between how we measured BP in SPRINT and how we did so in my clinic made me realize there must be a better way to measure BP in clinic.”
Researchers wrote that automated office BP consisted of the average three to five consecutive automated BP measurements taken 4 to 7 minutes apart by a validated device while patients rested alone.
Conroy and colleagues also wrote that 183 patients with elevated BP as defined by guideline-quality observed BP measurement and/or automated office BP took part in the home BP measurement program. Those patients with average home BP greater than 135/85 mm Hg provided home BP measurement results for medication.
“Initial [home HBP measurement] results in 183 patients with elevated office BP revealed white-coat BP elevation in 35% of untreated patients and in 37% of treated patients,” researchers wrote. “The prevalence of white-coat BP elevation was similar whether enrollment BP was by observed BP or [automated office] BP. Subsequent [home BP measurement] facilitated BP control in 49% of patients with elevated home BP." They added that that 68% of clinic staff involved in the study agreed that the automated office BP/home BP measurement program “positively influenced” hypertension management.
Conroy stated that PCPs not wanting to change their practice should not be a barrier to implementing the program described in the study.
“When I worked in a clinic that did not use [automated office BP and home BP measurement] I often ended up remeasuring the patient's BP myself after he or she had had some time to rest. This was disruptive to the visit, and there is a good chance that my remeasurement was not as accurate as it could have been. I feel more confident of the readings I get from staff now, and very rarely remeasure,” she said in the interview.
“I tell my patients that this BP collection only takes a little more time than a standard measurement and that we are trying to get the most accurate reading possible to make sure we are treating them correctly.” – by Janel Miller
The authors report no relevant financial disclosures.