Can clinical practice learn about measuring blood pressure from our veterinary colleagues?

To the Editor

Given that high blood pressure (BP) is now widely acknowledged to be the most significant contributor to (human) cardiovascular disease,1 its accurate assessment is of paramount importance for both diagnosis and treatment. Given the unfortunate inaccuracy of many BP assessments,2 I would like to share with your readers an extremely impressive BP assessment my wife and I witnessed today in the office of the veterinary doctor who takes care of our cats.

Our 13‐year‐old female cat, Sassy, was taken from the initial examination room to the area in which various tests are conducted. In due course, the veterinarian himself returned with a sheet of paper on which multiple values were meticulously recorded by hand and proceeded to discuss them with us. Five sequential assessments of systolic BP and diastolic BP had been made, and for each pair of readings the mean arterial pressure had been calculated. These values appeared in the first five rows of a 3×6 table, with the sixth row being populated with mean systolic BP, mean arterial pressure, and mean diastolic BP, respectively. For each parameter, a pattern that will be familiar to those clinicians who do take multiple BP readings was readily evident: the fifth systolic BP and diastolic BP readings (and the fifth calculated mean arterial pressure) were each considerably lower than the respective first values, and the descent from first to fifth values was close to a linear progression in each case. This rigorous assessment protocol allowed the veterinary doctor to make an optimally informed clinical assessment and treatment decision (an antihypertensive regimen was initiated).

While not actually using the term white‐coat hypertension in his discussions with us, the veterinary doctor was clearly cognizant of the ramifications of this phenomenon, and hence the nature of his assessment protocol. Given my familiarity with the literature on BP measurement methodology, I congratulated him on performing a much more comprehensive BP assessment than that received by the majority of human patients when visiting their clinicians’ offices.

The point of this Letter is certainly not to criticize individual clinicians, but rather to lament the current state of clinical practice that is largely controlled in multiple geographic regions by financial reimbursement systems that, in many cases, preclude the requisite time for conducting a rigorous assessment to be devoted to a patient: complex BP assessment strategies in a busy practice are therefore shrouded by impracticality. In contrast, the fact that we are fortunate to be able to pay the veterinary practice the full amount of a reasonable bill (no insurance company time‐quota expectations or negotiated discounts being involved) bestows the gift of clinically meaningful assessment time to the veterinarian and his patient. I am not naive to the enormous complexities of financing human health care, and the following is not an original thought: as a society, we must do better.3, 4, 5, 6 Hopefully, the originality here is capturing and communicating to your readers the humanity, methodological savvy, and commitment to time‐appropriate diagnostic and treatment skills of a veterinary doctor. It is hoped that, in the future, clinicians will become unshackled from reimbursement exigencies and hence allowed, on a routine basis, to practice likewise.

DISCLOSURE STATEMENT

The author reports no specific funding in relation to the preparation of this Letter to the Editor. No editorial support was used.