Doctors warned on single high blood pressure reading

Research finds that one high measurement should be impetus to "ramp up" blood pressure control.

By Andis Robeznieks, amednews staff. Aug. 16, 2004.

A single elevated blood pressure reading -- particularly an elevated systolic reading -- is a reliable predictor of future problems and should not be dismissed as a fluke.

That is the conclusion reached by William M. Tierney, MD, director of Indiana University School of Medicine's Division of General Internal Medicine and Geriatrics, Indianapolis, in a report recently published in the Annals of Family Medicine.

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"As students, we are told that blood pressure can vary greatly, that one should not rely on a single measurement," said Dr. Tierney in an e-mail. "Because our study showed that a single elevated measurement among patients under treatment for hypertension predicts a host of bad outcomes, it gives the physician an impetus -- and perhaps an excuse -- to ramp up blood pressure control whenever there is an opportunity to do so."

According to an Institute of Medicine report last year, 20 million of the 43 million Americans affected by high blood pressure are not treating it; 12 million of those being treated for hypertension still do not have it under control; and hypertension was a primary cause of death for almost 43,000 Americans in 1999.

Dr. Tierney said there were many reasons for undertreatment: patients might not know they have hypertension; some don't seek treatment; some might not take their medications; and doctors could be prescribing insufficient doses of medications.

One reason physicians may fail to prescribe sufficient doses is that patients often give excuses for why, on any particular day, their BP may be elevated, he said. "They tell me, 'I didn't take my medicine this morning,' or 'I ran in from the parking lot.' Our study showed that, regardless of what was happening with the patient, a single elevated blood pressure measurement was highly predictive of a whole host of bad outcomes."

Dr. Tierney added that the study reaffirms that systolic hypertension could endanger patients more than diastolic. "Physicians like me who were trained more than 10 years ago, were told just the opposite," he said. "This notion has been turned on its head, and our study reinforces this."

ADDITIONAL INFORMATION:

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"Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension," Annals of Family Medicine, May-June (www.annfammed.org/cgi/content/full/2/3/209)

"Closing the Quality Gap: Hypertension Care Strategies," U.S. Agency for Healthcare Research and Quality fact sheet, April (www.ahcpr.gov/qual/hypertengap.htm)

"Priority Areas for National Action: Transforming Health Care Quality," Institute of Medicine report, 2003 (www.nap.edu/books/0309085438/html)