Letters
Cardiovascular diseases Pharmacology
Volume 198 - Issue 1

Importance of ambulatory blood pressure in hypertension management

Authors:  Geoffrey A Head, Barry P McGrath, Mark R Nelson and Michael Stowasser

Med J Aust 2013; 198 (1): 26. || doi: 10.5694/mja12.11516
Published online: 21 January 2013
In reply: The cardiovascular risk associated with white coat hypertension itself is quite separate from the risk of treating white coat hypertension inappropriately. We agree that there are considerable issues associated with treating elderly patients for hypertension and possibly inappropriately treating white coat hypertensive patients. However, although white coat hypertension is more common among elderly patients, the condition needs to be considered in a broader context ...
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In reply: The cardiovascular risk associated with white coat hypertension itself is quite separate from the risk of treating white coat hypertension inappropriately.

We agree that there are considerable issues associated with treating elderly patients for hypertension and possibly inappropriately treating white coat hypertensive patients. However, although white coat hypertension is more common among elderly patients, the condition needs to be considered in a broader context of absolute risk where age is the most important determinant.1

Irrespective of its cause, the presence of orthostatic hypotension creates not only a greater risk of falling, but is also associated with higher all-cause mortality, and an increased risk of coronary artery disease mortality and stroke.2 While ambulatory blood pressure monitoring is not recommended to detect orthostatic hypotension, we nevertheless support its use to correctly determine blood pressure in white coat hypertensive patients, together with continuing home blood pressure measurement, particularly in the elderly who are at greater cardiovascular risk.

Authors

  • Geoffrey A Head1
  • Barry P McGrath2
  • Mark R Nelson3
  • Michael Stowasser4
  • 1. Department of Neuropharmacology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC.
  • 2. Monash University and Southern Health, Melbourne, VIC.
  • 3. University of Tasmania, Hobart, TAS.
  • 4. School of Medicine, University of Queensland, Brisbane, QLD.

Correspondence: geoff.head@baker.edu.au

Competing interests

Relevant disclosures provided in our original article (Med J Aust 2012; 197: 143-144; doi: 10.5694/mja11.11637).

Acknowledgements

This letter has been prepared by members of the Ambulatory Blood Pressure Monitoring Consensus Committee of the National Heart Foundation and the High Blood Pressure Research Council of Australia.

References

View this article on Wiley Online Library