MEDizzy - A 64-year-old black man presents to your office for routine

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HYPERTENSION

A 64-year-old black man presents to your office for routine follow-up care. You have treated him for many years for hypertension with a calcium channel blocker and a thiazide diuretic. His hypertension has been moderately well controlled with this regimen. He asks you whether having a home blood pressure monitor would be useful for his care. Which of the following statements regarding ambulatory blood pressure monitoring (ABPM) is true?

ExplanationThe correct answer is D. Cross-sectional studies show that blood pressure averages from ABPM correlate better with the presence of target-organ injury (especially left ventricular hypertrophy [LVH]) than office blood pressure averages. Also, prospective studies and population-based observational studies have shown that average blood pressure derived from ABPM predicts additional risk of cardiovascular (CV) events after adjustment for clinic or office blood pressure. ABPM is the best method to establish the presence of isolated clinic hypertension (so-called white-coat hypertension), which is defined as an elevation in BP that occurs only in the clinic setting, with normal BP in all other settings, in the absence of evidence of target-organ injury. Screening for white-coat hypertension is currently a reimbursable indication for ABPM by Medicare. Other uses for ABPM include assessment of hypotensive symptoms, episodic hypertension, and suspected autonomic dysfunction in patients with postural hypotension. ABPM is also useful in the evaluation of the occasional patient with hypertensive target-organ injury (LVH, stroke) whose office blood pressure is normal.