Agreement In Blood
Five successive patients repeated outpatient monitoring after two weeks showing good agreement (r = 0.86 for systolic pressure per day, r = 0.84 for 24-hour systolic pressure; mean difference – 2.2 (SD 5.9) mm Hg and −3 (4.8) mmHg). This confirms previous information on the reliability of ambulatory pressure.18 The “white coat” effect is important for the diagnosis and evaluation of high blood pressure control in primary care and is not a research artifact. When outpatient or domestic measurements are not available, repeated measurements performed by the nurse or patient should lead to much less unnecessary monitoring, initiation or modification of treatment. It`s time to end the use of high blood pressure rates, documented by GPs, to make treatment decisions. Prospective studies have highlighted the link between ambulatory blood pressure and outcome.1 Nevertheless, ambulatory monitoring devices are expensive (the machine used in this study cost £2000) and since about half of patients with high blood pressure are poorly controlled, each practice would need several machines to cope with the workload. While a more automated download of results should potentially reduce costs, personnel costs (set-up, verification, download, print) are currently high, meaning that overall costs are not reduced.7 High blood pressure is perhaps the most common reason for initiating lifelong drug treatment and ongoing management by physicians. Six prospective studies have shown that ambulatory blood pressure levels can be a much better predictor of target organ damage and subsequent adverse events than measurements taken in a clinic.1 However, these results have been found in research studies and, most often, in typical basic care centers, patients may have had a higher “alert reaction” than in everyday life with their family doctor or nurse. It is therefore important to determine whether the white coat effect applies as much outside of a research study as it does in typical family configurations. Figures 11 and 22 graphically illustrate the results of Tables 1, 1, 22 and 33 using data from the first row of Tables 11 and 2.2.
The overall over-compliance for systolic printing is due to the scatter plot (Fig. 1.1) illustrated by a moderate rank correlation (r=0.46); Cut-off points show that the doctor`s measurements are reasonably sensitive to the detection of high ambulatory pressure, but are poorly specific. The Bland Altman diagram (Figure 2)2) is summarized by the mean difference (the doctor`s measurements exceed the ambulatory pressure by an average of 18.9 mm Hg) and the positive rank correlation (Spearmans r=0.32). Thus, the difference between measurements by the doctor and ambulatory pressure increases with the increase in blood pressure. No studies compared all available measures in typical primary management of ambulatory blood pressure in patients with newly diagnosed and established hypertension Measurements performed by physicians were much higher than ambulatory systolic pressure (difference of 18.9 mm Hg, 95% confidence interval 16.1 to 21.7), as well as the latest measurements carried out in the clinic outside research institutes (19.9 mm Hg), 17.6 to 22.1). .