“White Coat” Effect Study as a Subclinical Target Organ Damage by Means of a Web Platform
“White-coat” effect designs those hypertensive subjects with “uncontrolled” office Blood Pressure (BP) but normal BP values when assessed by Ambulatory BP Monitoring (ABPM) or home BP monitoring (HBPM). Cardiovascular Risk (CV) risk is lower than those with real uncontrolled BP but it still remains unclear if it is comparable to those well controlled hypertensive subjects. This paper presents the study, the results and the web platform that was designed and implemented which make possible the study of the “White-coat” effect as a subclinical target organ damage. The large amount of information that needs to be gathered, calculated and analyzed makes specially complicated, even almost inviable, the development of the study by traditional manual routine. This motivated the implementation of a platform that permitted the doctors make the study with guarantees. The implemented web platform organizes the information of the patients, presenting all the necessary information for the study, including physical and clinical parameters or 48-h ABPM processing. It also automatically estimates glomerular filtration rate by MDRD equation (GFR) and Sokolow-Lyon criteria for left ventricular hypertrophy (LVH) as well as different statistics from the 48-h ABPM. The platform facilitates the doctor’s work avoiding large and tedious manual processes, minimizing the risk of possible miscalculations and analyzing all the information in a easier way. This framework helped the doctors to recognize the so called “ABPM effect”, and what is more important in the management of hypertensive subjects, it helps to better identify hypertensive subjects at poor cardiovascular prognosis.
KeywordsMedical informatics applications Web-based systems Internal medicine Hypertension Ambulatory blood pressure monitoring White coat effect
This work is supported by the Instituto de Salud Carlos III of the Spanish Government and FEDER funds of the European Union through the PI14/02161 and the DTS15/00153 research project.
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