London: Traditional
methods of testing for high-blood pressure are no longer adequate and risk
missing vital health signs, which can lead to premature death, a study co-led
by UCL has found. The
research, the largest ever cohort study of its kind, published in the New
England Journal for Medicine, assessed 63,000 doctors’ patients, who had their
blood pressure tested using traditional ‘in clinic’ methods, such as an
automated or hand operated devices. Separately,
the same patients, were also measured using a pocket-sized ambulatory blood
pressure monitoring (ABPM) device, which records blood pressure regularly
across a 24 hour period. This device is worn at home and takes measurements
every 20 to 30 mins.
High
blood pressure is the leading preventable cause of premature death globally and
affects approximately 25% of all adults. The study, which was co-led by
Professor Bryan Williams (UCL Institute of Cardiovascular Sciences), found that
measuring blood pressure using an ABPM device was 50% more accurate than the
traditional way blood pressure is measured in the clinic, and therefore a
significantly more accurate way of predicting a patient’s risk of death.
Using
an ABPM to measure the blood pressure at home, during day-to-day activities and
during sleep, also means known variations in patients’ blood pressure caused by
using ‘in clinic’ methods, can be more accurately diagnosed. Namely ‘masked
hypertension’, where blood pressure presents as normal in the clinic, but is
elevated out of office, and ‘white-coat hypertension’, where blood pressure is
elevated in the clinic, but normal outside the office.
“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,” Professor Williams said.
“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.
“With
a much more accurate assessment of a patient’s blood pressure, doctors will be
able to provide the most effective treatments at the earliest opportunity,
which will save many more lives.
“With
one billion people around the world having high blood pressure, this study, the
largest ever of its kind, should lead to changes in clinical practice across
the world, with the use of ABPM becoming much more common place.”
Professor
William’s research is supported by the National Institute for Health Research
UCLH Biomedical Research Centre.
Notes
The
cohort study, assessed over 60,000 patients who attended primary care in Spain
and covers a period of around 10 years. The research was promoted by the
Spanish Society of Hypertension and has been conducted by researchers from the
Universidad Autónoma de Madrid, health centers and other universities of
Madrid, Asturias, Barcelona, the CIBERs of Epidemiology and Public Health and
of Cardiovascular Research in Madrid, and UCL, in London.
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Media contact
Henry Killworth
Tel: +44 (0)20 7679 5296
Email: h.killworth [at] ucl.ac.uk