New Emphasis on Ambulatory and Home Blood Pressure Monitoring.

[Argirios Argiriou]

October 22, 2015

New Emphasis on Ambulatory and Home Blood Pressure Monitoring

Allan S. Brett, MD reviewing Siu AL. Ann Intern Med 2015 Oct 13. Shimbo D et al. Ann Intern Med 2015 Oct 13.

The U.S. Preventive Services Task Force recommends that we confirm hypertension with BP measurements outside the office.

In an update of a previously published guideline, the U.S. Preventive Services Task Force (USPSTF) has reaffirmed its recommendation that adults should be screened for high blood pressure (BP; NEJM JW Gen Med Jan 8 2008; [e-pub] and Ann Intern Med 2007; 147:783). That's not particularly newsworthy, but the new statement has an important addition: It recommends that we measure BP outside the clinical setting to confirm the diagnosis before starting treatment. The authors prefer ambulatory BP monitoring (ABPM), in which the patient wears a device that typically records BP every 30 minutes for 24 hours. When ABPM is not available, home BP measurements taken with a standard home BP unit are an acceptable alternative.

The authors review the literature supporting their shift to ABPM or home monitoring to confirm hypertension before starting treatment. Most of the discordance between in-office and out-of-office measurements is in the direction of higher office readings, potentially resulting in overdiagnosis and overtreatment if we depend solely on in-office measurements. Studies show that both ambulatory and home BP are independent predictors of adverse cardiovascular outcomes, after adjustment for office BP.

Comment

Many clinicians already use patients' home BP measurements both to corroborate diagnoses of hypertension and to adjust antihypertensive therapy. Twenty-four-hour ABPM is used less commonly for various reasons (e.g., lack of availability, concerns about cost and insurance coverage), but I suspect that the new USPSTF recommendation will result in increasing use of ABPM. However, out-of-office confirmation of hypertension is not necessary for patients with multiple severely elevated BP readings in the office or hospital. The Annals of Internal Medicine also has published a narrative review that provides additional detail on ambulatory and home monitoring.

Editor Disclosures at Time of Publication

Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

    Siu AL.Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015 Oct 13; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Shimbo D et al. Role of ambulatory and home blood pressure monitoring in clinical practice: A narrative review. Ann Intern Med 2015 Oct 13; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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