Blood pressure taken at home can predict cardiac troubles, researchers find
Wednesday, June 11th 2003, 12:00 am
News On 6
A portable device that tracks a patient's blood pressure day and night can help avoid misleading cases of ``white coat hypertension,'' or the way some people's pressure shoots up in the doctor's office, researchers found.
The multiple readings could let doctors decide more accurately who needs aggressive treatment to prevent complications and who can be spared medication.
Up to one-third of patients diagnosed with high blood pressure show the ``white coat'' effect during exam-room readings.
With ``ambulatory monitoring,'' heart patients have their blood pressure recorded every 30 to 60 minutes as they work, sleep, eat and perform other daily tasks over 24 hours. The device's arm cuff inflates automatically, sending measurements to a recorder worn on the hip.
Lead researcher Dr. Denis L. Clement, emeritus professor of cardiology at University Hospital in Ghent, Belgium, said that the average blood pressure over 24 hours was much better than a single reading taken in a doctor's office at predicting heart attacks or other cardiac trouble.
``This might be a useful methodology to decide which ones need treatment and which ones don't'' need heart medicines, said Dr. Donald W. LaVan, a spokesman for the American Heart Association and associate professor of medicine at the University of Pennsylvania. But he said more study is needed to be sure.
The study was published in Thursday's New England Journal of Medicine.
Clement and colleagues in Europe and the United States studied 1,963 patients with hypertension for an average of five years, during which 38 died of cardiovascular causes. Patients repeated the ambulatory monitoring annually.
The researchers found patients whose systolic blood pressure _ the top number in a blood pressure reading _ averaged 135 or higher over the 24 hours were about 75 percent more likely than those with lower pressures to develop dangerous heart problems. Those included heart attack, stroke, dangerous chest pain, diseased blood vessels or congestive heart failure.
The patients' average pressures when taken in a doctor's office were 10 percent to 20 percent higher than the 24-hour readings.
Dr. Vincent T. DeVita Jr. of the University of Connecticut School of Medicine wrote in an editorial that the study and other recent research support broader use of ambulatory blood pressure monitoring.
``Avoidance of unnecessary drug therapy would be a clear benefit of the monitoring procedure,'' DeVita wrote.