Recommendations from others
The European Society of Hypertension Working Group on Blood Pressure Monitoring recommends that subjects with blood pressure 140–159/90–99 mm Hg at several visits should have ambulatory blood pressure monitoring because 33% of those people will have white-coat hypertension. Women, nonsmokers, those with recent hypertension, a limited number of blood pressure determinations and small left ventricular mass on echo should also have ambulatory blood pressure monitoring. There should be a search for metabolic risk factors and target organ damage. Those patients aware that their blood pressures are lower outside the office should be considered for ambulatory blood pressure monitoring.10
The latest Joint National Committee report (JNC VII) indicates that ambulatory blood pressure monitoring may be useful to detect white-coat hypertension among patients with hypertension and no target organ damage, and those with episodic hypertension.11
CLINICAL COMMENTARY
Ambulatory BP monitoring better than home monitoring for ruling out white-coat hypertension
Joseph Saseen, PharmD, FCCP, BCPS
University of Colorado Health Sciences Center, Denver
Landmark placebo-controlled outcome-based trials demonstrating reduced morbidity and mortality with hypertension treatment did not differentiate essential from white-coat hypertension. Patients were included based on elevated office-based blood pressure measurements. Since we now know that the prevalence of white-coat hypertension is high, it should be ruled out before implementing antihypertensive therapy.
Ambulatory blood pressure monitoring is more accurate than home monitoring for ruling out white-coat hypertension. However, ease, simplicity, and availability makes home monitoring a more realistic option for routine clinical practice. When home blood pressure monitoring is used, reliable measurement devices (eg, newer automatic or manual home devices) should be used and patients should be instructed regarding proper use and documentation of blood pressure values to facilitate an appropriate clinical assessment.