Abstract (202):
Accurate blood pressure measurement is critical to properly identify and treat
individuals with hypertension. In 2005, the Canadian Hypertension Education
Program produced a revised algorithm to be used for the diagnosis of
hypertension. Subsequent annual reviews of the literature have identified two
major deficiencies in the current diagnostic process. Firstly, auscultatory
measurements performed in routine clinical settings have serious accuracy
limitations that have not been overcome despite great efforts to educate health
care professionals over several years. Thus, alternatives to auscultatory
measurements should be used. Secondly, recent data indicate that patients with
white coat hypertension (WCH) must be identified earlier in the process and in a
systematic manner rather than on an ad-hoc or voluntary basis so they are not
unnecessarily treated with anti-hypertensive medications. The economic and
health consequences of WCH are reviewed. This paper presents evidence for a
revised algorithm to diagnosis hypertension. Protocols for Home Blood Pressure
Measurement (HBPM) and Ambulatory Blood Pressure Monitoring (ABPM) are
reviewed. The role of Automated Office Blood Pressure (AOBP) is updated. The
revised algorithm strongly encourages the use of validated electronic digital
oscillometric devices and that out-of-office blood pressure measurements, ABPM
(preferred) or HBPM, should be performed to confirm the diagnosis of
hypertension.