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Advice from the BP Measurement Experts

SunTech Partner's Remote Patient Monitor Featured in the Economist

RDT logoWe love to highlight our partners’ achievements.  While some of these have been highly technical BP measurement endeavours in the pursuit of expanding scientific understanding such as experiments on the International Space Station or Mount Everest, the Economist trumpets one which may help anyone who travels by plane. Congratulations to our colleagues at RDT!

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Automated BP vs Manual BP Measurement: Which is Better? (Part 2 of 2)

Doctor, nurse, and patientIn my last post, I discussed the importance of informed debate in helping determine effective clinical practice. Specifically, I mentioned two recent journal articles about automated oscillometric blood pressure devices that arrived at two different conclusions. In that post I also provided some comments from the SunTech perspective. Today, I’ll share the perspectives of an experienced, practicing physician on the subject of automated BP devices versus manual sphygmomanometers.

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Automated BP vs Manual BP Measurement: Which is Better? (Part 1 of 2)

Automated or manual BP debateWhat’s a clinician to do? Debates about clinical trials, patient populations, and statistical analyses can seem hollow and distant when looking at an anxious patient in an exam room. At that moment, all that matters is what’s best for your patient. Yet clinically relevant data, and more importantly, rigorous discussion of that data, is the means to the end. Professional clinicians quite often need the former in order to effectively deliver the latter. To wit, two similar journal articles were recently published that arrived at two very different conclusions. Let’s take a look:

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Correctly Diagnosing High BP In Children: Help Needed!

Child Having His Blood Pressure Measured

(Update 6/10/15: The video referenced in this article is no longer available)

We recently came across a video report that originally appeared shortly after an article on the underdiagnosis of hypertension in children and adolescents was published in the August 2008 issue of the Journal of the American Medical Association (JAMA). The focal point of the report was the fact that 3 out of every 4 children who have high blood pressure have not been correctly diagnosed with the condition. This certainly would prompt the question “Why not?”

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Top 5 reasons your automated BP monitor gave an error code

The real problem is not whether machines think but whether men do.”  ~B.F. Skinner, Contingencies of Reinforcement, 1969

Sometimes, the more technology aims to help us, the more burden we take on to ensure it works. These days, automated blood pressure monitors are rapidly displacing mercury and aneroid sphygmomanometers in physician’s offices. As we move farther away from the 100 year old standard of listening for Korotkoff sounds to obtain a BP measurement, and towards the simple press of a button, there are a new set of usage factors that clinicians must remember when encountering problems.

Below is a list of the Top 5 reasons a clinician would encounter an error code when attempting to take an automated BP.

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Canadian Blood Pressure Study of Obese Children Yields Unexpected Results

Child on scaleA recent Canadian blood pressure study discovered that high blood pressure does not directly correlate with the rising obesity rate in pediatric patient populations.  Contrary to expected research outcomes, while most pediatric patients (ages 6-19) with high blood pressure were obese, not all overweight adolescents (a mere 3%) suffer from high blood pressure.

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Instrument Calibration Adds Error Potential in Manual BP Measurement

Blood pressure instrumentsIn previous posts, we have reviewed the 10 Steps to Accurate Manual Blood Pressure Measurement and 10 Factors That Can Affect Blood Pressure Readings.  As important as these details are, accurate measurement also requires two things:

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Blood Pressure Monitoring and Infection Control

Electron microscope imageInfection control has long been a hot topic for acute-care hospitals, and has been the focus of patient advocacy groups, the popular press, and legislators for some time. Old stories of sponges and instruments being left inside patients by harried doctors and nurses have been supplanted by nightmarish scenarios containing ominous-sounding names like Clostridium difficile and Methicillin-resistant Staphylococcus aureus. Unfortunately, for many patients in today's healthcare system, hypothetical scenarios and clinical studies have become a real matter of life and death. As a result, the spotlight is expanding to include other areas of the healthcare continuum-including long-term care facilities.

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Blood Pressure in your Medical Practice

SurveyThanks to the increasing concern regarding cardiovascular disease, blood pressure (BP) is one of the more well-known vital signs. Just about everyone has had their BP measured in a clinic. In the last few years, many track their own BP with the widespread availability and affordability of home monitors. Although experts in cardiology regard ambulatory blood pressure monitoring (ABPM) as the gold standard, it is not as frequently used in regular medical practice as in-office or home BP.
Each method has its benefits and disadvantages.

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Physician Acquired Blood Pressure Measurement is Higher than Nurse Acquired BP

Doctor takes patient's blood pressureThere are several different types of mild and/or episodic hypertension that ambulatory blood pressure monitoring (ABPM) can help a physician diagnose. However, the summary data that ABPM provides, the average daytime or 24-hour blood pressure as two examples, provides significantly different information than the one or two measurements taken in a clinic. Although this difference is one of the reasons that ABPM correlates better to cardiovascular outcomes than in-clinic BP, making it the gold standard for BP measurement, there are few detailed guidelines on the targets or thresholds for ABP like there are for in-clinic BPs like the popular 120/80 as a threshold for normal BP and 140/90 for hypertensive.*

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ASH 2010: A Focus on Improving Blood Pressure Measurement Technique

ASH logoAt the recent 25th annual scientific meeting for the American Society of Hypertension, there was a new program track targeted specifically to clinicians in primary care. The aim was to present the latest hypertension strategies and guidelines in a format that would be appropriate for the primary care physician but also for physician's assistants, nurse practitioners as well as seasoned hypertension specialists. While the session covered various current issues related to hypertension, one clear area of attention was a re-focus on blood pressure measurement methods.

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Damec Uses SunTech OEM NIBP Technology in Space

ABPM in the ISSSunTech Medical has had a long association with space research. Our first ambulatory blood pressure monitor, the Accutracker, and our stress BP monitor, Tango; have been used onboard the NASA space shuttle as far back as 1988. That association continued last year through an OEM partnership with advanced technology company, Damec.

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Ambulatory Blood Pressure Monitoring

Dr. William White interview video

An interview with Dr. William White from the 25th American Society of Hypertension Scientific Meetings

Over the course of the most recent American Society of Hypertension (ASH) Meetings held in New York City May 1 - 4th, outgoing ASH President Henry Black, MD had an opportunity to interview incoming ASH President William White MD. While their discussion covered many topics related to blood pressure monitoring, the focus was on ambulatory blood pressure monitoring (ABPM) and when and how to use it. This interview has been made available for viewing through WebMD's Medscape Cardiology page.

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International Hypertension Report Calls for Increased Awareness of Childhood Hypertension

Girl listening to teddy bears heartWe’ve already discussed how hypertension is a costly drain on worldwide health care systems and society in general, but this cost is only based on adult hypertension.  A recently published report advocates improving the awareness, identification, and treatment of pediatric hypertension and clearly describes the implications of continuing to neglect this problem in the pediatric population.  The prevalence of hypertension in children is about 3-5% of the population, but as obesity continues to rise in children, high blood pressure will likely increase making it even more important to raise the awareness of pediatric hypertension.

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Wrist versus Upper Arm Blood Pressure Measurement

BP measurement device

Is wrist BP an acceptable way to guide treatment for obese patients?

For over 100 years, upper arm blood pressure (BP) measurement has been the gold standard method to guide treatment decisions. This is the recommended technique by both the American Heart Association (AHA) and the European Society of Hypertension (ESH).

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Blood Pressure Measurement and Dialysis

Dialysis Patient

Dialysis is a medical treatment that performs the job of well-functioning kidneys in ridding the body of waste and helping it to maintain a proper balance of water and minerals. In hemodialysis, this is done by pumping a patient's blood through a dialyzer where the blood is cleansed, and the clean blood is returned to the patient.1 For the over 350,000 US 2and 40,000 UK residents3 who have lost their kidneys and/or kidney function and partake in dialysis regularly, the procedure provides for and defines the normalcy of daily life.

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ABPM Reimbursement in the US

Stethoscope and moneyAs a follow-up to the previous post about hypertension neglect in the US, I wanted to provide a bit more information about ambulatory blood pressure monitoring (ABPM). As we've discussed in previous blog posts, ambulatory blood pressure monitoring is a commonly-used tool for the identification and treatment of hypertension. Many health care providers are still unaware that ABPM is a reimbursable procedure although Medicare approved reimbursement in 2001. Routine use of ABPM can serve as a source of revenue for physicians while also improving the quality of care for patients.


 

There are new guidelines for US ABPM Reimbursement.

Download the new copy today!

 

Get My Free US ABPM Reimbursement Guidelines

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Blood Pressure Fluctuations: 'Warning Sign for Stroke'

BP fluctuationsLast week we addressed a report from the Institute of Medicine indicating that high blood pressure is not on the minds of the general public. However, in the most recent issue of the Lancet, a different view of hypertension was posted: what if your physician is looking at the wrong BP values? What if there is more to clinic blood pressure, or the measurement that your physician takes, than the average value?

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ABPM Used to Identify Masked Hypertension in Children with Chronic Kidney Disease

Masked hypertensionA recent article published in the Journal of the American Society of Nephrology (JASN)1 emphasizes the key role of 24 hour ambulatory blood pressure monitoring (ABPM) as a means to identify masked hypertension in pediatric patients with Chronic Kidney Disease (CKD). The study, published in January 2010, showed that many children with CKD who have normal blood pressure readings at the doctor's office often have high blood pressure readings at home. The researchers used ABPM to collect blood pressure measurements throughout the day including periods of sleep and normal daily activity, which provides a more accurate BP profile for each pediatric patient.

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Back to the Basics of Blood Pressure

Blood pressureAlmost everyone knows that blood pressure is one of the most important measurements in medicine. Every time a patient visits a physician's office or hospital, one of the first measurements taken is their blood pressure. Since blood pressure plays such a vital role in monitoring a person's overall health, I thought I would write about the basics of blood pressure and some of the terminology used in blood pressure measurement.

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