Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
J Clin Hypertens (Greenwich). 2020 Apr;22(4):605-613. doi: 10.1111/jch.13822. Epub 2020 Feb 12.
Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (-6.2 mm Hg, P < .01) and in the uncontrolled subgroup (-8.8 mm Hg, P < .001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.
动态血压监测（ABPM）被认为是一种很好的干预策略，可以避免高血压的误诊，并为高血压患者提供针对性治疗。本研究旨在评估 ABPM 在加纳一家心脏诊所对血压（BP）控制和降压治疗的贡献。回顾了 97 名年龄在 18-85 岁（平均 55 岁）的患者的病历。在同一天记录诊所血压（CBP）和动态血压的患者中，我们评估了不同的高血压表型、ABPM 后 6 个月 CBP 控制情况，以及在评估 ABPM 记录后，对控制和未控制的动态血压患者的降压治疗进行了改变。从基线时诊所和动态血压记录中，白大衣未控制高血压（WUCH）的患者比例为 19.5%（17/87），而隐匿性未控制高血压（MUCH）的患者比例为 16.1%（n=14）。在整个队列中，平均收缩压 CBP 显著降低（-6.2mmHg，P<.01），未控制亚组中 CBP 显著降低（-8.8mmHg，P<.001）。在回顾 ABPM 记录后，51.7%的治疗患者改变了他们的降压治疗方案。在 WUCH 和持续控制的高血压患者中，大多数患者的降压治疗被减轻或保持不变。在 MUCH 和真正未控制的高血压（TUCH）患者中，治疗得到了强化。总之，ABPM 改善了降压治疗和血压控制的临床决策。因此，在低/中收入国家的高血压和心脏诊所中，ABPM 应该更频繁地使用，以提供最佳的治疗。
