Volume 198 - Issue 1
Importance of ambulatory blood pressure in hypertension management
Author: Patrick Coleman
Med J Aust 2013; 198 (1): 25-26. || doi: 10.5694/mja12.11248
Published online: 21 January 2013
Published online: 21 January 2013
To the Editor: In their article, Head and colleagues stated that “white coat hypertension carries minimal actual CVD [cardiovascular disease] risk”.1 However, a failure to identify white coat hypertension, and to misdiagnose it as true hypertension, can lead to inappropriate prescription of antihypertensive medications, with associated financial costs and adverse effects such as falls and acute kidney injury, which are unrelated to CVD risk.
Although the ...
To the Editor: In their article, Head and colleagues stated that “white coat hypertension carries minimal actual CVD [cardiovascular disease] risk”.1 However, a failure to identify white coat hypertension, and to misdiagnose it as true hypertension, can lead to inappropriate prescription of antihypertensive medications, with associated financial costs and adverse effects such as falls and acute kidney injury, which are unrelated to CVD risk.
Although the published evidence relating to falls in this context is controversial, there is evidence to suggest that medication-induced hypotension may lead to preventable falls among elderly patients.2-4 The same is frequently true for acute kidney injury as a consequence of diuretic-induced dehydration and/or medication-induced hypotension leading to renal hypoperfusion.5
In practice, greater use of ambulatory blood pressure monitoring frequently helps to identify patients with white coat hypertension, thus avoiding inappropriate prescription of antihypertensive medications and averting the considerable associated costs and morbidity.
Competing interests
No relevant disclosures.
References
- Head GA, McGrath BP, Nelson MR, Stowasser M. Importance of ambulatory blood pressure in hypertension management. Med J Aust 2012; 197: 143-144. 0_CHDFJGHH
- Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women's Heart and Health Study. Age Ageing 2010; 39: 51-56. 0_i1142862
- Ali K, Ormerod E, Rajkumar C. Hyper- or hypotension in an older population: where do clinicians stand? Age Ageing 2010; 39: 4-5. 0_pgfId-2700474
- Choulerton J, Mudd P, MacMahon M. Withdrawing antihypertensives on the basis of orthostatic hypotension. Age Ageing 2010; 39: 518. 0_CBBCJIGJ
- Kohli HS, Bhaskaran MC, Muthukumar T, et al. Treatment-related acute renal failure in the elderly: a hospital-based prospective study. Nephrol Dial Transplant 2000; 15: 212-217. 0_CBBFDIHB