At-home ambulatory blood pressure monitoring a key research field

Ambulatory blood pressure (ABP) monitoring has been recommended by the American College of Cardiology (ACC) and the American Heart Association (AHA) as an area for further research for at-home management of hypertension.

The recommendation comes as the groups makes moves to better evaluate the patient outcomes in accordance with the 2017 Hypertension Clinical Practice Guidelines – with the release of new performance guidelines.

Cardiac Monitoring Service CEO Rudy Watkins welcomed the interest in ambulatory blood pressure (ABP) monitoring as a key field of research for improving patient care and outcomes, with increasingly strong interest from industry in ABP as a core service.

“Ambulatory blood pressure monitoring has been widely recognized as gold standard for measuring BP, so it makes sense to consider it for at-home patient management,” he said.

“With a device properly fitted by a trained clinician, ABP technology such as the Mobil-O-Graph reduces the burden on patients to manage fitting devices, timing and recording of BP data. Day night functions also ensure for more accurate blood pressure measuring.”

Along with 22 quality measures in the ACC AHA guideline, Donald E. Casey Jr., MD, chair of the performance measures writing committee, identified the Target: BP initiative – which provides clinicians with evidence-based methods to reduce HBP – as a key strategy to be used in improving patient outcomes.

It is an initiative set up by the AHA and American Medical Association, in response to the high rate of uncontrolled blood pressure and hypertension in the United States.

Target: BP uses three key principles – measure, act and partner to assist patients with getting their blood pressure under control (MAP). MAP calls on clinicians to measure blood pressure accurately, act rapidly with a clear treatment plan, and partner with patients to enable ongoing self-management to achieve better patient outcomes.

“We’re trying now to promote Target: BP; it’s something you can take off the shelf and get going if it’s embedded in a real-life delivery model. I think Target: BP is the secret sauce. It will be the way we’ll convince people to adopt this,” Dr Casey said.

In addition to self-managed blood pressure monitoring, ambulatory blood pressure monitoring was recognized in the performance guidelines as one of the best ways to monitor blood pressure at home. The committee highlighted the potential drawbacks with measuring blood pressure in a medical setting, such as white coat hypertension or masked hypertension.

“Office BP measurement is often unstandardized, despite the well-known consequences of inaccurate measurement. Errors are common and can result in a misleading estimation of an individual’s true level of BP if staff are not trained and a protocol is not followed,” the report said.

The decision to further investigate ambulatory blood pressure monitoring is timely, considering that 2019 saw the Center of Medicare and Medicaid Services (CMS) expand their coverage policy of hypertension.  Their coverage now includes coverage for cases of suspected masked hypertension, as well as the existing coverage of white coat hypertension. For more information on the expanded coverage policy, click here.