Ambulatory BP Monitoring to Diagnose Hypertension
SOURCE: Bloch MJ, Basile JN. Ambulatory blood pressure monitoring to diagnose hypertension — an idea whose time has come.
J Am Soc Hypertens 2016;10:89-91.
The United Kingdom Guidelines on Hypertension issued by the National Institute for Clinical Excellence and Health recommended use of ambulatory blood pressure monitoring (ABPM) as early as 2011. By their calculations, requiring the country’s general practitioners to routinely confirm blood pressure (BP) elevations through ABPM would lead to significant annual financial savings. Why? Because as many as one-third of patients originally diagnosed as hypertensive based on office BP measurement turn out to have white-coat hypertension and do not require treatment at all; hence, inexpensive ABPM makes sense.
Even the United States Preventive Services Task Force in its 2015 recommendations designated a level “A” recommendation to out-of-office BP monitoring to establish the diagnosis of hypertension, preferably ABPM, but home BP monitoring if ABPM is not available.
ABPM is an inexpensive (generally in the range of $125-$150) noninvasive tool that helps reduce patients with office BP elevations, which do not merit treatment. In addition to this benefit, it has been recognized for more than a decade that BP elevation as defined by ABPM is a much stronger predictor of cardiovascular outcomes than office BP measurement. We should follow the lead of our U.K. colleagues and perform ABPM (or at least home BPM) on a much more routine basis.
Research indicates clinicians should perform ambulatory blood pressure monitoring on a much more regular basis.
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