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Abstract

White coat effect and initial device stress may affect the results of 24 hour ambulatory blood pressure monitoring (ABPM). Although 48 hour monitoring is suggested to avoid it, the reliability of the test decreases while the cost doubles. For this reason, 568 patients with treated essential hypertension aged 18 to 80 years were investigated by 27 hour ABPM to observe the frequency and duration of white coat effect and the reliability of 27 hour ABPM in the Treatment and Ambulatory Blood Pressures (TRAP) Study. Pts were selected from 30 hypertension centers. Inclusion crieterion was being under control with drug treatment at least for 3 months. Pts with secondary or uncontrolled hypertension, pregnancy, heart, kidney or liver failure, major surgery, acute coronary event, coronary intervention or stroke for the last 6 months, atrial fibrillation or other types of major arrhythmias, hypertrophic cardiomyopathy, electrolyte disturbances, the use of digoxin, nitrates, KCI, lithium or major antidepressants were excluded. ABPM was applied for 27 hours and measurements were performed every 30 minutes between 07:00 AM and 11:00 PM, and every hour between 11:00 PM and 07:00 AM. The measurements made at the first 3 hours were compared with the measurements made at the same time on the next day. First 3 hour measurements are found to be highly correlated with the measurements made at the same time on the next day (all r> 0.5, p< 0.0001). On the other hand, first 3 hour measurements performed between 07:00 AM- 12:30 PM were found to be significantly higher than the measurements made at the same time on the next day. The differences between two day measurements on morning hours were significant (all p<0,05). Although there is a tendency for higher pressures in the first 3 hours, the difference between two day measurements were insignificant after 1:00 PM. These results imply that 27 hour ABPM instead of 24 hour ABPM may be beneficial to avoid white coat effect and initial device stress.

Grant/Research Support - Boehringer Ingelheim Ilaq Pic. A.S.

white coat effect, ambulatory blood pressure monitoring, device stress
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© American Journal of Hypertension, Ltd. 2001
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