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Townsend RR, Cohen JB. White Coat Hypertension & Cardiovascular Outcomes. Curr Hypertens Rep 2024:10.1007/s11906-024-01309-0. [PMID: 38761349 DOI: 10.1007/s11906-024-01309-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE OF REVIEW This review aims to inform the reader of the complexity of blood pressure responses when comparing blood pressure measured in the medical environment to that outside the medical environment. In addition, we summarize what is known about current predictors of white coat hypertension, reevaluate the relationship of white coat hypertension to cardiovascular outcomes, and provide some clinical guidance on management. RECENT FINDINGS Differences in outcomes exist when white coat effect occurs in unmedicated people versus the white coat effects in those on antihypertensive therapy. White coat hypertension is relatively common, carries a small but definite increase in cardiovascular risk, and is prone to conversion to sustained hypertension. Future research will hopefully tease out the roles of ancillary findings that characterize a white coat hypertensive (like modest elevations in creatinine, glucose and triglycerides) in the elevated cardiovascular risk, and test the effectiveness of mitigation strategies in these patients.
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Affiliation(s)
- Raymond R Townsend
- Perelman School of Medicine at the University of Pennsylvania, Renal Electrolyte and Hypertension Division, 122 Founders Building 3400 Spruce Street, Philadelphia, PA, United States.
| | - Jordana B Cohen
- Perelman School of Medicine at the University of Pennsylvania, Renal Electrolyte and Hypertension Division, 122 Founders Building 3400 Spruce Street, Philadelphia, PA, United States
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Desson Z, Sharman JE, Searles A, Schutte AE, Delles C, Olsen MH, Ordunez P, Hure A, Morton R, Figtree G, Webster J, Jennings G, Redfern J, Nicholls SJ, McNamara M, Deeming S, Doyle K, Ramanathan S. Improving the accuracy of blood pressure measuring devices in Australia: a modelled return on investment study. J Hum Hypertens 2024; 38:177-186. [PMID: 37938294 PMCID: PMC10844083 DOI: 10.1038/s41371-023-00866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 11/09/2023]
Abstract
The VALID BP project was initiated to increase the availability of validated blood pressure measuring devices (BPMDs). The goal is to eliminate non validated BPMDs and minimise over- and underdiagnosis of hypertension caused by inaccurate readings. This study was undertaken to assess the potential return on investment in the VALID BP project. The Framework to Assess the Impact of Translational Health Research was applied to the VALID BP project. This paper focuses on the implementation of the cost benefit analysis aspect of this framework to monetise past research investment and model future research costs, implementation costs, and benefits. Analysis was based on reasoned assumptions about potential impacts from availability and use of validated BPMDs (assuming an end goal of 100% validated BPMDs available in Australia by 2028) and improved skills leading to more accurate BP measurement. After 5 years, with 20% attribution of benefits, there is a potential $1.14-$1.30 return for every dollar spent if the proportion of validated BPMDs and staff trained in proper BP measurement technique increased from 20% to 60%. After eight years (2020-2028) and assuming universal validation and training coverage, the returns would be between $2.70 and $3.20 per dollar spent (not including cost of side effects of unnecessary medication or downstream patient impacts from unmanaged hypertension). This modelled economic analysis indicates there will be positive downstream economic benefits if the availability of validated BPMDs is increased. The findings support ongoing efforts toward a universal regulatory framework for BPMDs and can be considered within more detailed future economic analyses.
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Affiliation(s)
- Zachary Desson
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew Searles
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alexis Hure
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Rachael Morton
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Jacqui Webster
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Garry Jennings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | | | - Simon Deeming
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Kerry Doyle
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia.
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
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