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Advice from the BP Measurement Experts

Telehealth Monitoring May Win Big with New Government Regulations

telemedicineDoes anybody like government imposed penalties? Well, as is normally the case , it depends where you are as a stakeholder.

Readmission penalties drafted in the Affordable Care Act are set to kick in starting October 2013 in the form of Medicare reimbursement cuts to hospitals who have high rates of readmissions for certain health conditions including heart attack, pneumonia and heart failure. Other conditions will be included starting in 2015.

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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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Silent Killer Ravages US Population

Silent KillerHypertension, often called "the silent killer", is a medical condition that does not strike fear into the hearts of many people. Why? It often presents no noticeable symptoms.

Many people (myself included) don't feel the need to go to the doctor until they have (unbearable) symptoms of something being "wrong". It is a fair assumption then that if they are not going for regular check-ups with a healthcare provider, they are probably not monitoring blood pressure levels on their own either. It is also likely that some are even unaware that their blood pressure is at an unhealthy level.

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UC Berkeley Gets Blood Pressure Right

Nurse Reading on BeachSince it’s the summer, we’re doing more reading than writing. We came across this article from the University of California Berkeley School of Public Health and loved how it highlighted a lot of the topics we have written about in the past. From multiple tests to measuring blood pressure in both arms to the appropriate use of gold standard BP testing, it’s good to see agreement between healthcare providers and industry. Now it’s just a matter of putting this into everyday practice so it makes a meaningful impact on people’s lives. Enjoy the summer!

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3 Things to Consider When Measuring Your BP at a Kiosk

Valentine's Day Candy Box with StethoscopeThis Valentine's Day, when you are out making a mad dash to your local pharmacy for the perfect card, you may consider checking your blood pressure at the pharmacy's kiosk. We'd like to whisper sweet nothings in your ear about 3 things to consider while having your BP measurement taken at a kiosk.


While blood pressure checks have historically been standard at community health fairs and elder-care centers, the local branch of your bank is not necessarily where you expect a check up and reminder of tips on healthy living.  But with the trend in the US, the UK, and other countries of raising self-awareness for personal health, healthcare services and organizations are exploring new, proactive ways to bring simple services like education and monitoring to their communities. 

At a public shopping mall, Covenant Health has been running a multi-service kiosk, which uses automated BP monitors for self-measurement.  While this is not so different than the BP kiosks that have been in pharmacies, grocery stores, and other public places for many years, Wegmans, a grocery store chain in the east coast of the USA, understands that these health initiatives need to be supported by educational information and recommendations to see a clinician for credible, actionable diagnosis and treatment.  To aid in the education of this trend, the following are the top three factors to consider when you decide to have your blood pressure taken at a blood pressure kiosk:

  1. Remember that your blood pressure changes just like your heart rate.  Exert yourself by walking up the stairs or even just dealing with the stresses of the workplace, and your BP and heart rate may be higher than what you are used to seeing in a doctor’s office or at home.  Some level of this variability is normal.
  2. One measurement is just that… it’s one instance in time.  It’s one data point.  In fact, clinicians and experts in BP are increasingly placing more emphasis on the average of several measurements over a given period of time instead of focusing on just one measurement.  A single high measurement may be due to dealing with the stress of being in a public place like the mall or being sick.
  3. BP measurement is like any diagnostic test.  It’s not always 100% accurate. While there are standards that BP monitors, including kiosks, must meet in order to be sold on the market, automated BP devices are not fool-proof.  Some of the factors that affect BP measurements are covered in other blog posts:

Given these factors, it’s important to take the right perspective when you have your BP measured in a public place.  In fact, one group who studied the use of a public access kiosk found that over 70% of users had high blood pressure.  While this might be alarming, they came to the following balanced, sensible conclusions:

“These statistics clearly illustrate the heart-health challenges facing our city… However, they also show that the population of people using these downtown kiosks beat the national average in terms of blood pressure. The Wellness Stations are terrific tools in helping people gauge their own health.”

In the end, engaging people about their health in their daily lives is the goal, one for which kiosks may serve as a cost-effective solution.

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Determining BP Device Accuracy: Who Has It Right?

Bullseye Dart on a Manual StethoscopeAll caregivers need to trust the accuracy of automated blood pressure (BP) devices they use to make clinical decisions. But when considering one specific BP device versus another, how does one establish that trust? Well, an automated BP device that’s used to guide patient treatment is legally considered a medical device, and therefore must adhere to the regulatory guidelines for the markets in which it is sold.

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New Healthcare Law Means Big Penalties for Hospitals with High HAI Rates

Hospital feesHealthcare Associated Infections (HAIs) are one of the hottest topics in healthcare right now. Over 2,000,000 patients in the United States acquire HAIs, which adds an average of 8 days to the hospital stay and causes approximately 99,000 deaths per year.6 The total annual cost to treat these HAIs in the United States is between $35.7 billion and $45 billion with the average in hospital cost per patient between $20,549 and $25,903.

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Healthcare-Associated Infection (HAI) Rates Influencing Patients’ Hospital Selection

Empty patient waiting roomBeing a part of the healthcare industry, we know that reducing healthcare-associated infections (HAIs), such as MRSA (Methicillinresistant Staphylococcus aureus) and C.Diff (Clostridium Difficile), continues to be a top priority for hospitals everywhere.  What is surprising though is that based on a survey conducted in July 2011, prospective patients are becoming increasingly aware of a hospital’s ability to protect their patients from HAIs and are using this information as a major factor in determining where they seek care.

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Choosing an OEM Partner: 3 Ingredients to a Successful Partnership

oem partnershipIn our last OEM technology blog post, we discussed things to consider when deciding whether to work with an OEM clinical technology vendor.  If thinking through these issues encourages you to investigate further, here are three key ingredients to identifying the right partner who will give you the best chance for your ideas and products to succeed in today’s dynamic healthcare marketplace.
As you might expect from a partnership, the first two ingredients depend largely on the partners!

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Regulatory Changes: Are you prepared?

Street sign at the corner of Healthcare End and Reform WayThe regulatory world is changing. Countries are examining and changing the rules and regulations that govern the way businesses interact and make an impact. In the US, with his editorial article in the Wall Street Journal and his State of the Union Address, President Obama makes a clear message about government regulatory systems. He wants balance between commerce & safety, progress & common sense. Obama calls for regulations to be reviewed so that the US “(protects its) safety, health and environment while promoting economic growth.” While the call to update regulations is clear, the balance that is called for lies in a well-known, well-trodden, broad, gray area. It’s this same area that all countries are trying to define, regulate, and enforce for the good of their citizens.

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Concord grape juice lowers BP? Not so fast!

concord grape juiceThe New Year is upon us and a lot of us have declared to get healthier in 2011.  Whether you have started a new workout regimen or have changed your diet to consume more fruits and veggies, any change is good change, right?  Growing up in North Carolina, where we fry everything from chicken to green beans, I was never fond of eating healthy so my mother always stressed the importance of “drinking your juice” instead of so many soft drinks.  However, recent research may shed some light on the effects of juice consumption.  Being that SunTech Medical is your one-stop shop for blood pressure (BP) measurement expertise, let’s explore the effects juice consumption has on BP!

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Video: Consumer Reports Tests Home BP monitors

Home BP Consumer ReportThis news video reports on a clinical evaluation of select Home BP monitors recently completed by Consumer Reports. We were not surprised to see, among their findings, that the wrist monitors evaluated were not as accurate as upper arm monitors. We were encouraged that the video seems to indicate the evaluation was administered by two observers taking auscultatory readings with a stethoscope and mercury column where those results would serve as the basis to compare the automated monitors' results. This is truly the best method for performing clinical evaluations of automated, non-invasive BP monitoring technologies.

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Let's Bring in the New Year in Moderation

BP and alcoholAlthough some people like to “indulge” in alcoholic beverages to help bring in the New Year, you may want to take it easy if you have high blood pressure.  While it is common knowledge that high blood pressure increases your risk of cardiovascular diseases and that excessive drinking is not beneficial to your body; the combination of the two may be double trouble.

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Man Protests Outside Drug Store Over Faulty BP Monitor

Man ProtestingWe recently came across an article reporting on a man in Grand Forks, North Dakota, who is so upset about the erroneously high readings from his new BP monitor that he spent three days protesting outside the store he purchased it from*.

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Watching Your Favorite Sports May Be Bad for Your Blood Pressure

sports fan blood pressure riseHave you ever caught yourself yelling at the television when your favorite team drops a touchdown pass in the end zone or makes a fielding error late in the game?  We’re all guilty of it.  However, I feel obligated to share some bad news.  First, the coaches and players cannot hear you from the confines of your living room, and second, research shows that there is a direct link between spectator sports and an increased risk of cardiovascular (CV) events.  Dr. Franklin Zimmerman, from Phelps Memorial Hospital Center, recently published an article in the Journal of Clinical Hypertension investigating the blood pressure (BP) and heart rate (HR) response of baseball and football fans both before and during games.

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Masked Hypertension: What You Don't Know Could Kill You!

Masked hypertensionWhite-coat hypertension is a familiar term to most clinicians.  Patients with white-coat typically have elevated blood pressure measurements in the clinician’s office, but display normal BP measurements in their everyday environment.  The prevalence of white-coat hypertension varies from 15% to 20% of patients.  Conversely, there is another group of individuals whose hypertension often goes unnoticed by traditional methods of BP measurement.  These patients have normal in-office BP but elevated out-of-office BP.  This phenomenon is referred to as “masked hypertension” and is defined as having in-office BP < 140/90 mm Hg but daytime ambulatory or home BP ≥ 135/85 mmHg.

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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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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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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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CMEF 2010: China and Growing Awareness of Hypertension

SunTech Medical at CMEF 2010Earlier this year we wrote a blog post about the similarities of current healthcare challenges in both China and the US. Of particular note was the fact that Hypertension is the leading cause of premature deaths in China. We recently had an opportunity to meet and speak with many folks involved with the delivery of healthcare in this rapidly evolving market at the China Medical Equipment Fair (CMEF) held in Shenzhen April 18 - 21, 2010.

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