The Diagnostic Value of 24-Hour Ambulatory Blood Pressure Monitoring in Family Medicine Clinics.

Uvod: Arterijska je hipertenzija vodeći javnozdravstveni problem te čimbenik rizika za razvoj kardiovaskularnih i cerebrovaskularnih bolesti. Većinu bolesnika koji boluju od arterijske hipertenzije prate liječnici obiteljske medicine koji posjeduju potrebna znanja i vještine potrebne za dijagnosticiranje i liječenje te bolesti. U tome im uvelike pomaže 24-satno kontinuirano mjerenje arterijskoga tlaka (KMAT) koji ima veću dijagnostičku vrijednost u postavljanju dijagnoze arterijske hipertenzije od ambulantnog mjerenja vrijednosti arterijskoga tlaka (AT), a primjenjuje se i za praćenje kontrole bolesti te donošenje odluke pri odabiru terapije. Ovim radom željeli smo procijeniti korist uporabe 24-satnog KMAT-a u ordinaciji liječnika obiteljske medicine za postavljanje dijagnoze arterijske hipertenzije te praćenje bolesnika s već postavljenom dijagnozom. Bolesnici i metode: U presječnu studiju uključili smo 52 pacijenta u razdoblju od 4 mjeseca. Vrijednosti AT-a izmjerene 24-satnim KMAT-om usporedili smo s vrijednostima inicijalno izmjerenima u ordinaciji na dan pregleda. Razlika u postotku nekontrolirane hipertenzije dijagnosticirane ambulantnim mjerenjem AT-a, odnosno 24-satnim KMAT-om, testirana je primjenom χ2 testom. Povezanost vrijednosti AT-a izmjerenih u ordinaciji i KMAT-om testirana je Spearmanovim koeficijentom korelacije. Rezultati: Istraživanje je obuhvatilo 18 muškaraca i 34 žene. Prosječna životna dob ispitanika bila je 56,06 godina. Prosječan 24-satni sistolički tlak bio je 156,13 mmHg, a dijastolički 89,81 mmHg. Prosječne vrijednosti sistoličkog i dijastoličkog AT-a izmjerenog u ordinaciji bile su 141,98 mmHg i 84,52 mmHg. Nekontroliranu vrijednosti sistoličkoga tlaka dokazanu KMAT-om imalo je 47/52, a dijastoličkoga tlaka 36/52 pacijenata. Nekontrolirane vrijednosti sistoličkoga tlaka izmjerenog u ordinaciji registrirane su u 29/52, a dijastoličkog u 9/52 pacijenta. Zaključak: Dobiveni rezultati mjerenja pokazali su da postoji pozitivna korelacija između vrijednosti arterijskih tlakova izmjerenih u ordinaciji i 24-satnim KMAT-om. Primjena KMAT-a pridonosi pravilnijem postavljanju dijagnoze arterijske hipertenzije te boljoj kontroli vrijednosti AT-a.Introduction: Arterial hypertension is a leading public health problem and a risk factor for the development of cardiovascular and cerebrovascular diseases. Most patients suffering from hypertension are monitored by family medicine physicians that have the requisite knowledge and skills needed to diagnose and treat this disease. This is greatly facilitated by 24-hour ambulatory blood pressure monitoring (ABPM), which has more diagnostic value for arterial hypertension than clinical measurement of blood pressure (BP) values and is also used for monitoring disease management and deciding on the therapy of choice. This article assesses the utility of 24-hour ABPM in family medicine clinics for establishing the diagnosis of arterial hypertension and monitoring patients with a previously established diagnosis. Patients and Methods: We included 52 patients in a cross-sectional study over a period of 4 months. BP values measured using 24-hour ABPM were compared with values initially measured at the clinic on the examination date. The difference in the percentage of uncontrolled hypertension diagnosed by clinical BP measurement in comparison with 24-hour ABPM was tested by applying the χ2 test. The association between BP values measured at the clinic and those measured by ABPM was tested using Spearman\u27s rank correlation coefficient. Results: The study comprised 18 men and 34 women. The average age of the participants was 56.06 years. Average 24-hour systolic pressure was 156.13 mmHg, and average diastolic pressure was 89.81 mmHg. The average values of systolic and diastolic pressure measured in the clinic were 141.98 mmHg and 84.52 mmHg, respectively. Uncontrolled systolic pressure demonstrated by ABPM was found in 47/52 patients, while 36/52 patients had uncontrolled diastolic pressure. In clinical measurements, uncontrolled systolic and diastolic BP values were registered in 29/52 and 9/52 patients, respectively. Conclusion: The measurement results demonstrate a positive correlation between BP values measured at the clinic and those measured using 24-hour ABPM. The application of ABPM contributes to correctly establishing the diagnosis of arterial hypertension and improved BP management