RESUMO
INTRODUCTION: Out-of-Office Measurement of Blood Pressure (BP) is recommended in addition to office BP for the diagnosis and follow-up of hypertensive patients. Ambulatory Blood Pressure Monitoring (ABPM); Home Blood Pressure Monitoring (HBPM); and Self-Monitoring of BP (SMBP) are the currently available options and their indication may vary according to the context. The aim of the present study was to assess how Out-of-Office Measurement of BP takes place in clinical practice and its impact on BP control in a public tertiary outpatient clinic. METHODS: We evaluated 225 consecutive patients seen at a high-complexity public outpatient facility (mean age: 66.7 ± 11.9 years; female: 62.7%). All patients were routinely requested to perform SMBP according to a prespecified institutional protocol. ABPM and HBPM were indicated for selected cases at the discretion of the attending physician. Patient Adherence to Out-of-Office Measurement of BP was labeled into 5 possible categories: a) No Measurement; b) ABPM; c) HBPM; d) Adequate SMBP e) Inadequate SMBP. Patient Adherence was also stratified according to sex, age, number of antihypertensive drugs, schooling, length of follow-up at the facility, comorbidities and availability of BP monitor at home. Rates of BP control were related with Patient Adherence, as well as with the aforementioned variables. RESULTS: 87.5% of the study population reported having a BP monitor at home. However, adding up the 5 possible categories, adequate Out-of-Office Measurement of BP was available in only 46.7% of the sample (40.9% of the patients did not bring any measurement; 13.8% underwent ABPM; 32.9% adequate SMBP; 12.4% inadequate SMBP; 0% HBPM). Availability of a BP monitor at home (p<0.001) and the number of antihypertensive drugs in use (p=0.019) were strongly associated with adherence to SMBP. Prevalence of smoking was 2 folds higher (7.5% vs 3.4%) in those who returned without SMBP. Rate of BP control based on office BP was 42.6% (79.5% of the sample was under ≥3 classes of antihypertensive drugs). Out-of-office BP measurements were not associated with higher rates of BP control (p=0.377), but allowed to identify a White Coat Effect (WCE) in 1 out of 3 patients with uncontrolled BP according to office BP (WCE prevalence: 29 % among uncontrolled patients vs 3.9% among controlled ones. CONCLUSIONS: Outof-Office Measurement of BP is still an unmet need in the treatment of hypertension.
