How is ABPM Used, and What Data Will it Provide?
ABPMs can easily be configured by a nurse or medical assistant to monitor the patient’s BP at specific preset time periods, such as every 20-30 minutes in the awake hours, and every 60 minutes during the patient’s reported anticipated sleep period.
The device should be worn for a minimum of 24 hours so it can capture dynamic readings while the patient is engaged in usual activity, in their home and work environments, and during their sleep periods.
After the 24 hours, the information is downloaded to a computer for review.
The numerous readings provide a plethora of information for clinical decision making as to the person’s actual BP load and BP patterns as well as time and date stamped BP and pulse measurements. Additionally, some ABPM devices provide other critical details, such as activity levels, ambient temperature, and barometric pressure, which may aid in diagnosis.
Beyond the basic raw data, the software will provide the clinician helpful tools, such as graphs and diagrams, to highlight the BP loads, sleep percentages, a variety of means (including 24-hour, daytime, and nighttime means), high/low BP measurements, Circadian/Nocturnal rhythms, and irregular pulses.
Altogether, this data paints a picture of not only hypertension but of the patient’s unique patterns to elicit proper decision making for clinical management.
The initial target of managing BP should be aimed at evaluating morning BP. After morning control, the next goal would be to measure dynamic BP during the sleep cycles with ABPM and with a goal to keep nocturnal BP controlled at <110/656. What Type of Providers Should Use ABPM?
Given the urgency aimed at lowering BP thresholds, including a focus on early intervention to reverse heart and brain disease progression, morbidity and mortality, ABPM should be used by primary care providers, health departments, obesity and diabetic clinics, wellness centers, managed health groups, nurse or pharmacy hypertensive clinics, along with cardiology and renal specialty clinics.
With its wide range of diagnostic capabilities, efficiency, and ease of use, ABPM should be used early and frequently when hypertension is suspected, given the large number of patients who are going undiagnosed or suffering consequences of uncontrolled hypertension.
ABPM has been recognized by many as a gold standard in diagnosing hypertension5,6, and as of 2015, the United States Preventative Services Task Force (USPSTF) found it to be the best method to diagnose and confirm hypertension12. The CMS also set the standard that ABPM is a valid, useful and cost-effective tool for diagnosing hypertension WCH when it added reimbursements for the procedure in 200213.
Beyond medical providers, ABPM is becoming the standard of care among groups like AETNA17, HealthNet, Kaiser and Columbia University when diagnosing and evaluating BP patterns such as WCH, Masked Hypertension, and more.
In keeping with the new ACC/AHA guidelines and goals to minimize cardiovascular events by 30%4, there is growing evidence that ABPM is a key diagnostic tool in assessment and management of hypertension.
Because ABPM can uncover BP patterns that cannot be detected in-office or with HBPM, it should be a go-to tool in any healthcare provider’s toolkit when faced with diagnosing and controlling hypertension, which is a proven factor in improving cardiovascular outcomes and limiting the development of patient morbidity or additional conditions.
If you are interested in utilizing ABPM in your practice, please contact us to find out more.