Jennie B. Jarrett and Linda Hogan are with the St. Margaret Family Medicine Residency Program at the University of Pittsburgh Medical Center. Corey Lyon is with the University of Colorado Family Medicine Residency, Denver. Kate Rowland is with the Rush Copley Family Medicine Residency, Aurora, Illinois.
This novel method of identifying patients with uncontrolled hypertension correlates well with ambulatory BP monitoring.
A 64-year-old woman presents to your office for a follow-up visit for her hypertension. She is currently managed on lisinopril 20 mg/d and hydrochlorothiazide 25 mg/d without any problems. The patient’s blood pressure (BP) in the office today is 148/84 mm Hg, but her home blood pressure (HBP) readings are much lower (see Table). Should you increase her lisinopril dose today?
Hypertension has been diagnosed on the basis of office readings of BP for almost a century, but the readings can be so inaccurate that they are not useful.2 The US Preventive Services Task Force recommends the use of ambulatory BP monitoring (ABPM) to accurately diagnose hypertension in all patients, while The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends ABPM for patients suspected of having white-coat hypertension and any patient with resistant hypertension, but ABPM is not always acceptable to patients.3-5
HBP readings, on the other hand, correlate well with ABPM measurements and may be more accurate and more predictive of adverse outcomes than office measurements. Furthermore, the process is often more tolerable to patients than ABPM.6-8 If the average home BP reading is > 135/85 mm Hg, there is an 85% probability that ambulatory BP will also be high.8