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Advice from the BP Measurement Experts

Check out the latest ABPM related blogs we have to offer. 

ABPM Could Be Exactly What The Patient Needs

ABPM Can Catch Overnight DippingThe above title is how author Craig Bowron, MD capped off his recent article “Traditional blood-pressure cuffs not that reliable.” As I was reading the article, I was pleased to see how successful the 15-physician clinic in Minneapolis had been with implementing an Ambulatory Blood Pressure Monitoring (ABPM) program to identify, diagnose and manage their hypertensive patients. One physician was quoted as saying “It’s been breathtaking to see how much difference there can be between office blood pressure readings and what we’ve found with ambulatory [ABP] monitoring”. The practice was able to  lower or end treatment on 13% of their patients after ABPM testing revealed that they were being over-treated. Conversely, 18% had their medication added or increased as their ABPM results showed they were under-treated.

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Don't Break a Hip: How ABPM Can Help

As we have all heard time and time again hypertension is a prevalent public health issue, but it affects the elderly at a much higher rate. A newly published study now warns that "caution" is needed when initiating new antihypertensive drugs to treat elderly patients. The findings, published last month in the Archives of Internal Medicine (AIM), showed that elderly patients had a 43% increased risk of having a hip fracture within the first 45 days following the start of new antihypertensive treatment.1 It is reportedly "'the first study to demonstrate an immediate increased risk of hip fracture on initiation of antihypertensive drug therapy in community-dwelling hypertensive elderly patients'". The researchers also hypothesized that the most likely cause of the hip fractures were falls related to orthostatic hypotension, which can have symptoms such as dizziness and fainting.2


The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC), the American Society of Hypertension (ASH) and the National Institute for Clinical Excellence (NICE) recommend regular monitoring for patients who start antihypertensive therapy. So how can we best monitor these patients? JNC and NICE both recommend the use of in-office measurement.3,4 ASH encourages the use of Ambulatory or Home BP monitoring.5
"elderly patients had a 43% increased risk of having a hip fracture within the first 45 days following the start of new antihypertensive treatment"

Ambulatory BP monitoring (ABPM) is widely recognized as a tool for diagnosing hypertension. But it is also a useful tool for monitoring the efficacy of antihypertensive treatment, evaluating optimal BP control in patients with postural hypotension, and aiding in the assessment of patients with hypotensive symptoms that occur with antihypertensive medication.4,6

Clearly, as the AIM study has shown, monitoring could be beneficial for some patients at the onset of antihypertensive treatment and ABPM would be an ideal candidate given its proven value for this specific application. But we want to hear your thoughts. How do you monitor elderly patients starting antihypertensive drug treatments in order to monitor for orthostatic hypotension?

Sources

  1. Archives of Internal Medicine: The Risk of Hip Fracture After Initiating Antihypertensive Drugs in the Elderly, http://archinte.jamanetwork.com/article.aspx?articleid=1392493#METHODS
  2. Heart Wire: Starting BP meds ups risk of hip fracture in elderly, http://www.theheart.org/article/1477231.do?utm_medium=email&utm_source=20121121_EN_Heartwire&utm_campaign=newsletter
  3. NICE Quick Reference Guide: Hypertension, http://www.nice.org.uk/nicemedia/live/13561/56015/56015.pdf
  4. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, http://hyper.ahajournals.org/content/42/6/1206.long
  5. ASH Position Paper: When and how to use self (home) and ambulatory blood pressure monitoring, http://www.ashjournal.com/article/S1933-1711(08)00047-8/abstract
  6. New England Journal of Medicine: Ambulatory Blood-Pressure Monitoring, http://www.nejm.org/doi/full/10.1056/NEJMra060433
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American Society of Hypertension Urges CDC to Use ABPM

Oscar 2 ABPM Device

Last week, we blogged on the recent report from the Centers for Disease Control and Prevention (CDC) that noted some pretty serious concerns about our national state of health as it relates to hypertension and its potentially deadly effects.

This week, we want to draw your attention to a press release from the American Society of Hypertension urging the CDC to incorporate ambulatory blood pressure monitoring (ABPM) as a way to apply a more "sensitive and specific tool for assessing blood pressure in its national surveys."1

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Interval Exercise: A New Approach to Lowering BP

Breaking Up Your Exercise May lower BP more EffectivelyExercise has long been recommended to patients wanting a non-pharmaceutical approach to achieving lower blood pressure (BP). The American Heart Association (AHA) specifically recommends:

  • At least 150 minutes of moderate intensity aerobic physical activity (2 hours and 30 minutes) each week.
  • Incorporate your weekly physical activity with 30 minutes a day, at least 5 days a week.
  • Physical activity should be performed in episodes of at least 10 minutes, and preferably, should be spread throughout the week.
  • Include flexibility and stretching exercises.
  • Include muscle strengthening activity at least 2 days each week.1
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Speculation over implementation of NICE Guidelines on ABPM begins

nice-guidelines-abpmThree months ago, the National Institute for Health and Clinical Excellence (NICE) in the UK released new guidelines for managing hypertension in adults. The new recommendations call for the use of Ambulatory Blood Pressure Monitoring (ABPM) to confirm a diagnosis of hypertension when a patient has a clinic BP reading of 140/90 mmHg or above. One of the major questions raised was how this would be implemented.

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