The Effective Diagnosis And Treatment Of Hypertension By The Primary Care Physician: Impact Of Ambulatory Blood Pressure Monitoring

Abstract: Background: Ambulatory blood pressure monitoring (ABPM) has been described as an effective method for the diagnosis and formulation of the treatment of hypertension by the primary care physician. Methods: Sixty patients selected from a suburban private primary care practice participated in a study that compared measurements of office blood pressures using a mercury sphygmomanometer with the same pressures recorded by ABPM. Results: Blood pressures and blood pressure loads measured by ABPM were significandy lower than blood pressures and pressure loads recorded in the office setting. Conclusions: Blood pressure recorded by ABPM differed from the same measurements made by office or casual sphygmomanometry. Use of ABPM changed diagnosis or treatment of hypertension in borderline and antihypertensive drug-treated patients. Ambulatory blood pressure monitoring is a useful tool for the diagnosis and treatment of hypertension by the primary care physician. It can be used to identify white-coat hypertension in various patient populations. (J Am Board Fam Pract 1992; 5:457-65.) The cause of primary (essential) hypertension is unknown, and it seems improbable that a single cause will explain the diverse hemodynamic and pathophysiologic derangements described under the rubric of essential hypertension. Hereditary factors undoubtedly predispose individuals to hy-pertension, but the exact mechanism is unclear. Environmental factors (e.g., dietary sodium, obe-sity, diet, and stress) seem to act mostly in geneti-cally susceptible persons. The diagnosis and treatment of hypertension as they relate to the practicing primary care physi-cian have been the focus of three reports compiled by the Joint National Committee on Detection