Are we overtreating hypertensive patients? Chronobiologic vs. sphygmomanometric evaluation of ambulatory antihypertensive therapy.
The purpose of this prospective study was to compare two methods of evaluating antihypertensive treatment efficacy: the traditional sphygmomanometric method and automatic home recording. Thirty hypertensive patients were studied who had been on antihypertensive therapy for at least 3 months. In the first 3 weeks of study their therapy was left unchanged and their diastolic blood pressures, measured with the traditional sphygmomanometer (weekly morning visit in the outpatient clinic; three successive recordings at 5-min intervals; subject seated), were always higher than 95 mmHg. During the following 8 weeks, the physician tried to reduce diastolic blood pressure to not greater than 90 mmHg by changing or increasing the therapy. Before and after any modification in therapy, noninvasive, automatic home, blood pressure monitorings for 24 hours were obtained and analyzed with Halberg's method of single cosinor, but were not made available to the physician until the end of the study. Automatic recordings showed that 18 patients had already had a circadian diastolic mesor less than or equal to 90 mmHg under the original drug regimen. By changing or increasing the therapy, no additional pressure decrease was seen in the home pressure recordings of the whole group of patients, whereas the sphygmomanometric diastolic pressures of 15 patients fell under 90 mmHg. Our study provides additional evidence that casual sphygmomanometric measurements can be misleading when one tries to assess the efficacy of antihypertensive therapy, and a cause of potential overtreatment.
Portaluppi
F
F
Institute of Clinica Medica, University of Ferrara, Italy.
Montanari
L
L
Ferlini
M
M
Capanna
M
M
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D015924:Blood Pressure Monitors; D002909:Chronobiology Phenomena; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D014665:Vasodilator Agents