Key result
ABPM linked to ~6 mm Hg reduction in clinic systolic BP.
Why the study?
Ambulatory blood pressure monitoring (ABPM) is considered a good strategy to avoid misdiagnosis of hypertension and allow targeted treatment, but its contribution to BP control and therapy in a Ghana cardiac clinic was unclear.
Observational (n=97)
No
Mean Difference: -6.2
p-value: p=<0.01
ABPM may guide therapy changes and lower clinic BP in low-resource cardiac clinics; leaves open whether routine adoption improves hard outcomes.
Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (-6.2 mm Hg, P < .01) and in the uncontrolled subgroup (-8.8 mm Hg, P < .001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.
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Ntani et al. (2020) conducted an observational in hypertension (n=97). Ambulatory blood pressure monitoring (ABPM) was evaluated on Change in average systolic clinic blood pressure in the overall cohort (MD -6.2 mm Hg, p=<0.01). Ambulatory blood pressure monitoring led to antihypertensive therapy changes in 51.7% of patients and significantly reduced average systolic clinic blood pressure by 6.2 mm Hg (P<0.01).
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