24-Hour ambulatory blood pressure monitoring in primary care.
BACKGROUND
Both the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension in Adults and the British Hypertension Society have made recommendations for the use of ambulatory blood pressure monitoring (ABPM) in select patient populations. This demonstration project explores the feasibility of a 24-hour ABPM service in assisting physicians with decisions regarding the implementation and modification of antihypertensive therapy.


METHODS
After physician referral, patients met with a pharmacist for evaluation of their blood pressure. The pharmacist obtained a medication profile and instructed each patient on the proper use of the monitor. Patients completed an activity diary while wearing the monitor. After analysis of the reports, the pharmacist forwarded recommendations and the 24-hour blood pressure data to the referring physician.


RESULTS
Sixty patients took part in the demonstration project. The primary reasons for referral included evaluation of suspected isolated office hypertension, drug resistance, blood pressure control in diabetic patients, and suspected drug-induced orthostatic hypotension. The referring physicians accepted 100% of the pharmacists' therapeutic recommendations. Unnecessary therapy was avoided in 12 of 40 of patients with suspected isolated office hypertension (30%), and more aggressive treatment was started in 6 of 7 of patients with type 2 diabetes (87.5%).


CONCLUSIONS
This project shows that a 24-hour ABPM consultation service can provide useful information for determining which patients have isolated office hypertension and in guiding drug regimen modification for patients with diabetes, suspected resistant hypertension, or drug-induced alterations in blood pressure.
Gardner
S F
SF
Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock 72205, USA.
Schneider
E F
EF
D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care