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6. To date, there is only one low-quality RCT of nearly 1,300 participants with primary hypertension which compared clinical outcomes for those whose antihypertensive treatment was guided by 24-hour ambulatory BP monitoring versus by usual office-based practice.46 While ambulatory BP monitoring-guided management was associated with a significant reduction in cardiovascular events and mortality after 4.7 years of follow-up, this trial had significant methodologic limitations (including differential exclusions after randomization and highly asymmetric loss to follow-up between trial arms).
%PDF-1.4 %���� The site is currently in development and will continue to be updated as more content is developed and reviewed by an expert committee of doctors, researchers and health care professionals. 0000001386 00000 n 0000006920 00000 n 0000007080 00000 n ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Arterial Hypertension.

Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. 0000088575 00000 n

0000003820 00000 n Because they have had initially high screening readings, they remain at higher risk for hypertension and follow-up is warranted.These expert-consensus recommendations have been provided to give practitioners some guidance for the follow-up of patients diagnosed with hypertension.Evidence-based recommendations for follow-up BP assessment are very important as they frequently inform BP treatment initiation and/or intensification.

This is supported by prognostic studies showing an increased risk of cardiovascular events above or near this threshold The need to further assess patients when a home BP measurement is less than 135/85 mm Hg (and white coat effect is suspected) is based on the Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) trial, where home/self BP monitoring was specific (89%) but not sensitive (68%) in its ability to detect white coat hypertension A standardized protocol for performing home BP monitoring is outlined in Table 2. Periodic health exams, visits for assessment of other cardiovascular risk factors, urgent office visits for neurological or cardiovascular related issues, and medication renewal visits are examples of clinical visits considered appropriate for blood pressure measurement Accurate assessment of blood pressure is necessary for proper diagnosis, precise cardiovascular risk assessment, to gauge the necessity for intervention, and to monitor treatment effect.
Using ambulatory BP monitoring (see Guidelines in Direct evidence supporting the merits of BP screening is scarce; thus, this recommendation is largely based upon expert consensus and specifically, the reality that if BP screening is not performed, hypertension cases will remain undetected.Blood pressure screening frequency and timing may vary between patients and is left to the discretion of each practitioner. Early diagnosis can facilitate faster blood pressure control and, in clinical trials of higher risk hypertensive patients, early control was associated with reductions in cardiovascular events Studies supporting the prognostic value of ABPM include the Office versus Ambulatory Pressure (OvA) study There are also several studies supporting the prognostic value of home/self BP monitoring and, thus, the inclusion of this technique for the diagnosis of hypertension. [Level of Evidence: Not stated] 0000011390 00000 n In general, the closer the initial readings are to normal, the greater the risk of misclassification Background and references are cited in the appropriate sections below.This expert consensus recommendation is made to ensure that these individuals are not lost to follow-up. 0000001207 00000 n

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