Management of hypertension after ambulatory blood pressure monitoring.

OBJECTIVE

To study the test-ordering behavior of practicing physicians regarding ambulatory monitoring of blood pressure and to assess changes in patient management after this study.

DESIGN

Cross-sectional assessment of physicians' practice habits regarding the ordering of ambulatory blood pressure monitoring and a longitudinal study of patient management after monitoring.

SETTING

Physicians' offices in central Connecticut.

PARTICIPANTS

Two hundred thirty-seven consecutive patients referred by 65 community- and hospital-based physicians.

MEASUREMENTS

Indications for ambulatory blood pressure monitoring, changes in diagnosis and therapy, and office blood pressures before and after the ambulatory blood pressure study.

RESULTS

The main indications for ordering the test included borderline hypertension (27% of studies ordered), assessment of blood pressure control during drug therapy (25%), evaluation for "white coat" or "office" hypertension (22%), and drug-resistant hypertension (16%). After the ambulatory blood pressure study, only 13% of the patients had further testing (for example, echocardiography); the diagnosis was changed in 41% of the patients, and antihypertensive therapy was changed in 46%. In 122 patients for whom data were complete, office blood pressure measured by the referring physician decreased from 161/96 +/- 22/12 mm Hg before the ambulatory blood pressure study to 151/86 +/- 27/12 mm Hg 3 months after the study (P = 0.004 for systolic blood pressure and P < 0.001 for diastolic blood pressure). One to 2 years after the study, office blood pressure was 149/86 +/- 24/12 mm Hg (P > 0.2 compared with 3 months after the study). Seventy-two percent of the patients had a lower office blood pressure within 3 months of the ambulatory blood pressure study.

CONCLUSIONS

Practicing physicians use ambulatory blood pressure recordings for appropriate indications, and data from the monitoring studies affected the management of patients with hypertension.