Clinical use of ambulatory blood pressure monitoring in a Veteran's Medical Center.
BACKGROUND: The lack of prospective data on the relative value of ambulatory blood pressure compared with office blood pressure as well as concern about increased costs have led to cautious endorsement of such monitoring in the clinical arena. Several consensus bodies have reviewed the scientific evidence and have suggested appropriate and limited clinical indications for ambulatory blood pressure monitoring. OBJECTIVE: To evaluate the ordering habits of the clinicians in regard to the recent introduction of such a monitoring service at our Veteran's Administration Medical Center and to assess its influence on practice.METHODS: During the 18 months after the introduction of ambulatory blood pressure monitoring, 95 successful blood pressure recordings were performed. These studies were requested for patients typical of the aging World War II veteran population in the USA. The blood pressure monitoring test was ordered mostly by attending physicians (44%) but physician extenders (34%) and medical residents (22%) also ordered a significant proportion of the tests. The main indication for ambulatory blood pressure monitoring was suspicion of white-coat hypertension in untreated patients and suspicion of white-coat effect in treated hypertensives (45%). RESULTS: The results had an important impact on the management of patients, 42% of untreated patients remained without pharmacologic treatment whereas, for 36% of treated patients, increases in medication were avoided. With the 73 patients for whom complete follow-up blood pressure data were obtained, there was a significant decline both in office systolic (by 8 +/- 15 mmHg, P = 0.001) and in office diastolic blood pressure (by 6 +/- 8 mmHg, P = 0.001) after 3 months. CONCLUSION: Clinical providers in a Veteran's Administration Medical Center used ambulatory blood pressure monitoring appropriately after its introduction and found the information provided to be of clinical value.
Mansoor
GA
Medical Service, Newington Veteran's Administration Medical Center, Newington, Connecticut, USA.