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Advice from the BP Measurement Experts

Do I REALLY Need Treatment for Hypertension?

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Were You Properly Diagnosed?

A vast amount of physicians are diagnosing hypertension without properly assessing a patient’s blood pressure during the course of a 24-hour period using Ambulatory Blood Pressure Monitoring. Simply put, ABPM provides valuable diagnostic information that in-clinic and home blood pressure monitoring systems are incapable of measuring including:

  • BP variability and a more accurate estimation of true blood pressure
  • Overnight changes in blood pressure (dipper status)
  • Morning surges in blood pressure
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Does My Pet Have High Blood Pressure?

Picture of a Golden Retreiver with Owner in a Park

Believe it or not, your pet can have high blood pressure too! That being said, the significance of this is a bit different than it would be for you and me. Hypertension in cats and dogs is almost always secondary, which means it is caused by an underlying condition or disease. Because secondary hypertension is a signal that something else is wrong, blood pressure screening is a great way to discover other health issues in your pet such as acute kidney disease or hyperthyroidism. BP screening can help to prevent serious organ damage if a condition or disease is caught in its early stages.

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JNC 8 BP Guidelines: To Treat or Not to Treat Hypertension?

JNC 8 BP Guidelines: To Treat or Not to Treat Hypertension?

As word gets out about the controversial blood pressure guideline changes published by the Eighth Joint National Committee (JNC 8), the big question for clinicians is “what impact does this have on how we treat patients?” Fortunately, Duke University researchers are looking into this for you. An April 2014 JAMA analysis states that almost 6 million Americans currently taking BP medications might be able to throw them away based on new guidelines and another 13.5 million previously-diagnosed patients with uncontrolled hypertension now meet healthy blood pressure benchmarks.

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Guidelines Galore

ASH ISH release new GuidelinesIn previous blogs, we have talked about the publication of new guidelines related to the treatment of hypertension such as the ESH/ESC Guidelines for the Management of Arterial Hypertension (available here). At the end of 2013, two additional guidelines were published; one from the Eighth Joint National Committee (JNC 8) and the other as a result of a joint effort by the American Society of Hypertension (ISH).

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Pay-For-Performance Achieves Better Hypertension Control?

Pay-For-Performanc Achieves Better Hypertension Control?As the Affordable Care Act becomes more established here in the US, one of the many new initiatives it brings to bear is pay-for-performance. Pay-for-performance is an incentive that encourages physicians to deliver a higher quality of care, as opposed to a reimbursement model that drives more tests and procedures. While similar to the system the National Health Service (NHS) has had in the UK for several years now, there is much debate over whether this method will improve the healthcare situation in the US. One group of researchers recently tested the pay-for-performance model by using the rate of hypertension control as their quality metric.

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ABPM Makes a Lot of Cents

ABPM ReimbursementAmbulatory Blood Pressure Monitoring (ABPM) is a commonly-used tool for the identification and treatment of hypertension with a variety of clinical applications including identification of white-coat hypertension, diagnosis of masked hypertension, monitoring the efficacy of anti-hypertensive treatment, and identification of resistant hypertension. One common question from both those preparing to implement ABPM in their practice, and current ABPM users alike, is whether or not it is a reimbursable procedure.

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World’s Leading ABPM Experts Publish Position Paper

ESH logoJust two months ago the European Society of Hypertension (ESH) released its new guidelines for the management and treatment of arterial hypertension at its annual meeting. ESH remains active in publishing guidance documents and has now released its latest position paper. The topic is Ambulatory Blood Pressure Monitoring (ABPM).

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Central BP Measurement Takes Center Stage at ESH 2013

AtCor Medical SphygmoCor XCEL

Latest trends in blood pressure measurement technique have shifted to central blood pressure (CBP) and understanding its affect on us. This topic was prevalent at the recent European Society of Hypertension (ESH) meeting in Milan, especially with regards to understanding how CBP can be used in the future to guide clinical cardiovascular treatment. CBP is your aortic blood pressure near the heart and can be obtained both invasively and noninvasively. The invasive process involves inserting a pressure sensor into the aorta, which is not very desirable especially when reliable noninvasive products exist today.

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Meaningful Use Incentives Becoming Less Meaningful

Healthcare providers are frustrated with EMRIs it just me, or are healthcare providers becoming increasingly fed up with all of the new, fancy-schmancy healthcare IT 'solutions' that seem to be proliferating faster than ever before? Meaningful Use incentives have been the catalyst for the adoption of electronic medical records at an unprecedented rate, but some clinicians, administrators, and facility managers are beginning to question the value of what they've bought into as they struggle to electronically capture patient information—things like blood pressure, temperature, exam results, and other vitals.

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Get Out of the Office for Better BP Measurement

Out of Office BPThough we state it often, we at SunTech Medical aren't the only ones touting the utility of monitoring BP outside of a clinical setting. A recent article published by a northeastern regional news website advocates for the use of home BP (HBPM) and ambulatory BP monitoring (ABPM) to diagnose and monitor hypertension. An estimated 50% of patients experience either white coat hypertension or masked hypertension. Therefore, as Dr. David Landers is quoted in the article, "'One blood pressure reading in the office is not useful. What you need is more data points.'"

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ESH Releases New Guidelines on Hypertension and BP Measurement

ESH and ESC Guidelines 2013This year marked the 23rd scientific meeting of the European Society of Hypertension (ESH) on "Hypertension and Cardiovascular Protection". While the ESH annual meeting is always filled with the latest in hypertension research, this year's highlight was the presentation of the newest edition of the ESH/ESC (European Society of Cardiology) Guidelines for the management of arterial hypertension.

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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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Beet High Blood Pressure

 beetrootjuiceMy mother was recently diagnosed with high Blood Pressure (BP). She talked to her doctor about the best ways to help control her high BP. The doctor prescribed a blood pressure medication and recommended she should eat more fruits and vegetables in addition to adding 30 minutes of exercise to her daily routine.

I was happy that the doctor recommended a healthy lifestyle to her in addition to the medication. I wouldn't call myself a health nut, maybe an enthusiast – which is why I liked the idea of alternatives for her. Recently, I read a study in the American Heart Association journal Hypertension, about how drinking a cup (250ml) of beetroot juice a day could help lower High BP.

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May 17th is World Hypertension Day

World Hypertension DayEach year, the World Hypertension League designates May 17th as World Hypertension Day. With over 1.5 billion worldwide suffering from hypertension (high blood pressure), we at SunTech Medical would like to do our share to draw attention to this single biggest risk factor for death linked to heart disease, stroke, kidney disease and diabetes. For more information on World Hypertension Day and tips on prevention and treatment of Hypertension, you can visit the World Hypertension League website and download the World Hypertension Day brochure today.

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World Health Organization Releases 2013 Global Brief on Hypertension

Diagnosing Hypertension

On April 7th, the World Health Organization (WHO) celebrated their annual World Health Day in order to draw international attention to important global health issues. Each year, the WHO highlights a different global health concern and, and we found it noteworthy that the focus of this year is controlling high blood pressure.

 

As part of their efforts, the WHO released a new publication, “A Global Brief on Hypertension” (link below), which is now available as a free download at the official WHO website. The brief describes how hypertension is contributing to the growing burden of heart disease, stroke and kidney failure and premature death and disability. The WHO authors explain how hypertension is both preventable and treatable and provides guidance on how governments, health workers, civil society, the private sector and individuals can reduce hypertension and its impact.

 

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Love Lowers BP and Healthcare Costs

Love Lowers BPAh, love. Valentines Day brings it front and center – roses, candy, and sentiments to loved ones. Aside from the moments of terror and corresponding spike in blood pressure that can be brought on by the realization that you have forgotten to plan for this celebration, the emotion of love can be of invaluable help in reducing stress and blood pressure.

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Top 5 Blog Posts of 2012

Holiday trees illustration

As we look forward to the coming new year, we wanted to take a moment to look back at the most popular posts from this year. We'd like to wish all of our friends and followers of Blog@SunTech a Happy Holidays and safe New Year. Unless claims that the end of the world is upon us are true, we'll see you next year!

  1. You're Doing It Wrong: New Study on BP Measurement
  2. Top 7 Reasons You Should Be Using Automated Blood Pressure for Cardiac Stress Testing
  3. Determining BP Device Accuracy: Who Has It Right
  4. 5 Myths About Vital Signs Automation and EHR's
  5. 3 Things to Consider When Measuring Your BP at a Kiosk
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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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Should Manual BP Get the Boot

Manual BP MeasurementThere's a bit of a debate going on in October's issue of the Journal of Hypertension about the best way to measure blood pressure. Everyone agrees that it should be done using a cuff placed over the brachial artery, but the similarities sort of end there.

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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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