Support Icon

Blog @ SunTech

Advice from the BP Measurement Experts

Does Your New Physician Make Your Blood Pressure Rise

High Blood Pressure MeasurementA recent article in the Journal of Clinical Hypertension does a colorful yet effective job of describing the transient effects of White Coat Hypertension (WCH) when meeting  a new physician.  Studies show that patients who are not hypertensive but show high BP readings when visiting a new doctor for their first time can continue to present with these elevated BP readings for three to six visits.  Although treatment for hypertension based on these measurements is not recommended, the gold standard diagnostic test for WCH, a 24-hour study with an ambulatory blood pressure (ABP) monitor, can more effectively determine whether treatment is, in fact, needed.

Continue reading
84517 Hits

Implantable blood pressure monitors: Science fiction or reality?

blue waveformAt SunTech Medical, we’re always thinking about blood pressure (BP) and how current measurement tools and techniques might be improved. In many ways, “routine” blood pressure measurement hasn’t changed much over the last 100 years. But innovative tools like ambulatory blood pressure monitoring (ABPM) have helped us learn about the importance of masked hypertension, overnight dipping, and blood pressure variability, their impact on clinical outcomes, and the subsequent guidance of hypertension treatment.

Continue reading
54574 Hits

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?”

Continue reading
146355 Hits

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.

Continue reading
44580 Hits

Guidelines for Ambulatory Blood Pressure Monitoring in Children

Child patientHaving covered the recently rising awareness of childhood hypertension, we thought it appropriate to highlight the guidelines of using ambulatory blood pressure monitoring (ABPM) in children. The American Heart Association has published comprehensive recommendations on this topic...


 

...Which can be found here.  Additionally, separate commentary by Dr. Bruce Alpert, one of the contributing authors, can be found on the SunTech White Papers section.

In some ways, the guidelines for its use on children is not so different than for adults.  However, you should be aware of the following nuances:

  • Check the monitor’s qualification: While clinical validation to the US standard (AAMI) and to the British standard (BHS) are mandatory before a product is allowed on the market, an ABPM specifically needs to be validated for use on children and adolescents.  Make sure to inquire with the manufacturer or representative that the ABPM has been tested to and passed the validation with children as subjects.
  • Use equipment tuned for children: The ABPM should be lightweight, small, quiet, and well-protected when it is worn by the child.  More importantly, an appropriately-sized cuff must be used.
  • Use ABPM software that analyzes children’s BP readings according to the previously discussed thresholds based on age, gender, and height.

The AHA statement goes into significantly more detail.  However, the three guidelines above are the most important to successfully using ABPM on children in a medical practice.

14611 Hits

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.

Continue reading
119778 Hits

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.*

Continue reading
41280 Hits

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.

Continue reading
82418 Hits

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.

Continue reading
154077 Hits

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

185241 Hits

Report Indicates US Neglects Hypertension

Hypertension

The Institute of Medicine (IOM) released a report last week recommending strategies to address the "neglected disease" of hypertension in the US. Many people do not realize that high blood pressure is one of the leading causes of death in the US, and it is a risk factor for heart attack, stroke, and kidney failure. One in three US adults has hypertension, and less than half of them have it in control, resulting in an estimated cost of $76 billion in 2010.

Continue reading
46886 Hits

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.

Continue reading
93965 Hits

A Guide to Ambulatory Monitoring -- How to Instruct Your Patients

Dr. Henry Black interview videoDr. Henry Black, president of the American Society of Hypertension, explains the usefulness of ambulatory blood pressure monitoring, the short-comings of home bp, and why home bp will never replace ABPM.

Note: To view this video you will need to register for a free membership to Medscape Today.

123582 Hits

Ambulatory Blood Pressure Monitoring Used for “The Dr. Oz Show”

Dr. Oz uses ABPMOn Tuesday, September 22, The Dr. Oz Show explored how stress is destroying women's bodies and revealed an Ultimate Anti-Stress Checklist. Ambulatory blood pressure monitoring was used to assess how stress affected a busy mom's blood pressure throughout the day. The data produced an overall blood pressure profile which is a key indicator of her overall health. Dr. Oz pointed out a few hypertensive readings during the test, which were directly related to stressful tasks (e.g. her son spilling candy all over the grocery store).

Continue reading
111064 Hits

The Importance of Ambulatory Blood Pressure Monitoring...continued

Oscar 2 ABPM in use

Part 2 of 2: What is ABPM?  Why should I get a test? ABPM Blood Pressure Guidelines.

Most hypertension opinion leaders regard ambulatory blood pressure monitoring as the gold standard for risk assessment since it is superior to both clinic and home BP measurement [4],[5]. Ambulatory blood pressure monitoring (ABPM) is a 24 hour blood pressure test in which readings are taken every 15-30 min during the day and 20-60 min during asleep hours. To learn more about ABPM, please, check out this ABPM video.


Why should I get an ambulatory blood pressure test?

ABPM provides information which home BP and clinic BP cannot including:

  1. an estimate of true, or mean, blood-pressure level
  2. diurnal rhythm of blood pressure
  3. blood pressure variability

More benefits to ABPM are summarized in the table below.

Benefits of Ambulatory Blood Pressure Monitoring over Home BP and Office BP [4]

  ABPM
Home BP
Office BP
Mean (true blood pressure)
Yes Maybe No
White-coat hypertension Yes Maybe No
Masked hypertension
Yes Maybe No
Diurnal blood pressure rhythm Yes No No
Dipping status
Yes No No
Morning surge
Yes Maybe No
Blood pressure variability
Yes Maybe No
Duration effects of BP meds
Yes Maybe No

You can see from the table above that there are several key benefits to ABPM, but you may not know why they are important. I'll highlight a few on the list.

  • White-coat hypertension: White-coat hypertension is when a patient's BP is measured high in the office because the patient might be nervous in that environment. As many as 30% of diagnosed hypertensive patients are later found to have white-coat hypertension. It is important to differentiate between white-coat and sustained hypertension, since white-coat patients do not actually need anti-hypertensive medications.
  • Night-time BP: ABPM also provides a night-time BP profile. Night-time hypertension is correlated with higher risk of cardiovascular end outcomes.
  • BP medication assessment: Finally, ABPM is especially useful for recently diagnosed hypertension or the assessment of BP meds. As mentioned earlier, the majority of Americans with hypertension do not have it under control, but they may not know that. An ABPM test can help physicians prescribe the right medications to keep blood pressure in control and reduce future cardiovascular risk. In fact, when ABPM is incorporated into the hypertension diagnostic and treatment process, up to a 14% savings in the cost of healthcare has been calculated.[6]

What are blood pressure guidelines for ABPM?

Most people are familiar with the 140/90 mmHg guidelines for blood pressure. Blood pressure guidelines for ambulatory monitoring are a little lower. The American Heart Association recommends an overall 24-hr average of 130/80 or lower. The 7th Joint National Committee states that awake ambulatory bp measurements should be below 135/85 and asleep measurements should be below 120/75. The European Society of Hypertension (ESH) states that normal awake bp is 135/85, but optimal awake 130/80. The ESH also recommends that normal asleep bp is 120/70, but optimal asleep 115/65.

If you have any questions or comments regarding your experiences with ABPM, we'd love to hear about it!

 

Back to Part 1 of "The Importance of Ambulatory Blood Pressure Monitoring"

 


 

[1] http://familydoctor.org/online/famdocen/home/common/heartdisease/treatment/770.html

[2] World Health Organization. (2003). 2003 World Health Organization (WHO)/ International Society of Hypertension (ISH) statement on the management of hypertension. Journal of Hypertension, 21, 1983-1992.

[3] American Heart Association Statistics Committee and Stroke Statistics Committee. (2009). Circulation, 119, e21 - e181.

[4] Pickering, TG, Shimbo, D, and Haas, D. (2006). Ambulatory Blood-Pressure Monitoring. New England Journal of Medicine, 354, 2368-2374.

[5] Urbina, E. et al. (2008). Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment. A Scientific Statement from the American Heart Association Arthrosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension, 52, 433-451.

[6] Krakoff, LR. (2006). Cost-Effectiveness of Ambulatory Blood Pressure. Hypertension, 47, 29-34.

279394 Hits

The Importance of Ambulatory Blood Pressure Monitoring

Oscar 2 ABPM in use

Part 1 of 2: Defining Blood Pressure, Office and Home Blood Pressure Measurement.

In order to understand the importance of ambulatory blood pressure monitoring, one first needs to understand why blood pressure is important to measure. While hypertension specialists understand the value of ambulatory blood pressure monitoring, some family practice physicians don't understand the utility of ABPM over home blood pressure monitoring. Let's start with the basics....

Continue reading
209475 Hits

Larger Blood Pressure Cuffs, Please!

measurement tape imageIf you ask any nurse or doctor about blood pressure (BP) cuffs, one of the most common questions you will receive is "Why can't we get a larger cuff?" With the obesity epidemic increasing globally, the need for larger blood pressure cuffs is becoming more pronounced. The World Health Organization states that "currently more than 1 billion adults are overweight - and at least 300 million of them are clinically obese."1

So why can't BP cuff manufacturers just make larger size cuffs?

Continue reading
187578 Hits