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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
More inWhite Papers  

a dr taking blood pressure imageApril 26 2018

A study has found regular blood pressure readings taken in the home setting over 24 hours are a significantly stronger mortality predictor than if taken by the GP. 

The study highlighted the impact of ‘white coat’ blood pressure, where a patient’s BP reading may be higher because of anxiety of being in a GP surgery compared to at home. It has prompted calls for patients to have blood pressure monitored every 20-30 minutes over 24 hours using ambulatory readings before clinical decisions about treatment are made. 

Data was used from over 63,000 adults between 2004-2014, with a follow up average of 4.7 years. During that period, 3,808 patients died from any cause, and 1,295 of these patients died from cardiovascular causes. Analysis found that 24-hour systolic pressure was more strongly associated with all-cause mortality and cardiovascular mortality than the clinic systolic pressure readings.

The study, published in the New England Journal of Medicine, used a cohort of Spanish patients and involved Spanish and UK researchers. 

Research co-lead Professor Bryan Williams, director of the NIHR University College London Hospitals Biomedical Research Centre, said: “For decades doctors have known that blood pressure measured ‘in-clinic’ could be masked or elevated, simply because the patient was in a medical setting, and this could lead to the wrong or a missed diagnosis.

“This research is a clear game-changer, as for the first time, it definitively shows that blood pressure measured regularly during a 24-hour period predicts the risk of heart disease, stroke and death much better than blood pressure measured in a doctor’s surgery or clinic.

“Quite simply, measuring blood pressure over 24 hours is what doctors and medics should be using to make clinical decisions about treatment.”

Links:
JR Bangas et al. ‘Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality’. N Engl J Med 2018; 378:1509-1520             
UCL announcement      
NIHR announcement    

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