What advantage does ABPM have over clinic based BP readings?

For over 100 years, surgery based blood pressure measurement using manual or validated automatic devices has been used to diagnose  and manage hypertension. Protocols and guidelines to establish whether a patient is hypertensive are based on recommendations produced by national and international bodies including the joint NICE/British Hypertension Society guidelines (DUE FOR REVISION August 2011) and the European Society of Hypertension. Surgery based “snapshot” measurements are quick, cheap to carry out and should be accurate when carried out with validated blood pressure monitors but they do have disadvantages.

“White Coat” impact greater than previously thought

The problem of “White Coat” Hypertension, where blood pressure can be elevated by up to 30mm/Hg and last for up to two hours, is well documented and it may be present in up to 20% of the population. Research recently published in the BMJ by Professor Arduino Mangoni, from the University of Aberdeen, sheds new light on the issue and states that “Ambulatory blood pressure monitoring is the tool of choice to correctly diagnose high blood pressure."

A key question is will the new NICE guidelines on hypertension due in August 2011 recommend ABPM?

Compelling financial argument in favour of ABPM monitoring

As well as a clinical argument for the wider adoption of ABPM monitoring in the current economic climate, there is also a compelling financial one. It is estimated that 90 million prescriptions for blood pressure lowering drugs are issued by the NHS, at a cost of £840 million per annum. If 20% of these are misdiagnosed, that represents potentially huge cost savings to the NHS for a relatively small initial investment.

Published by PMS Instruments