Treating hypertension is an important issue in most patients in cardiology, nephrology, endocrinology and geriatrics. Many patients with hypertension are not properly regulated but some patients are being overdosed. There is a relation between antihypertensive therapy and risk of falls and fractures.Objective:
Routinely, BP is measured in all patients in hospital outpatient clinics. Usually, this is done by and during presence of a nurse or a physician just before or after taking an ECG. Clinical decisions are usually based on such measurements. 7 different Danish departments confirmed that this was their procedure in most outpatients.Design and method:
We did an audit of consecutive patients referred from our own cardiology outpatient clinic over a period of 18 months for ambulatory monitoring of blood pressure (AMBP). Nineteen were within the age group from 30–45 yr and fourtyfive were older than 75 yr.Results:
In the young age group, BP was 156/99 mmHg in the outpatient clinic but 141/89 mmHg during AMBP in the daytime. SBP measured by these two techniques showed poor aggrement (Lin concordance correlation coefficient 0,38). Mean difference was 15 mmHg.Results:
In the old age group, clinic BP was average 171/87 mmHg but only 132/73 mmHg during AMBP in the daytime. In 7 patients, the antihypertensive medication was intensified before the AMBP, but 5 were reduced after AMBP due to low BP. SBP measured by these two techniques showed no agreement (evt. Lin concordance correlation coefficient 0.04). Mean difference was 38 mmHg. Using daytime ambulatory BP as reference, we found these values for clinic BP: sensitivity 92%, specificity 13%, positive pred value 30% and neg. predictive value 80%.Conclusions:
Clinic BP is not a useful tool in older patients. Average error in our database was 39 mmHg systolic, and clinical decisions made were often wrong. Older patients who had high BP measured, mostly had normal or low BP in the home. In our outpatient clinic, 60% of clinic BP were above 140/90 mmHg. Clinic BP in outpatient clinics should be abandoned and replaced by better methods in order to improve management of hypertension.