Document Detail


Management of hypertension after ambulatory blood pressure monitoring.
MedLine Citation:
PMID:  8480956     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
J M Grin; E J McCabe; W B White
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  118     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1993 Jun 
Date Detail:
Created Date:  1993-05-27     Completed Date:  1993-05-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  833-7     Citation Subset:  AIM; IM    
Affiliation:
University of Connecticut School of Medicine, Farmington.
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Care
Blood Pressure Determination / methods*,  utilization
Connecticut
Cross-Sectional Studies
Female
Humans
Hypertension / diagnosis*,  prevention & control*
Male
Middle Aged
Monitoring, Physiologic / utilization
Physician's Practice Patterns / statistics & numerical data*
Questionnaires
Referral and Consultation / statistics & numerical data

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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