The US Preventive Services Task Force (USPSTF) recommended that physicians use ambulatory blood pressure monitoring to confirm the existence of hypertension in newly suspected cases before instituting therapy. The USPTF has been making recommendations on appropriate health screening for years now. Their new positions now says that patients 40 years of age or older with an initial BP of 130/85 or higher should be screened for hypertension annually instead of every 3-5 years as previously suggested. The recommendation includes annual blood pressure screening for all adult African Americans. Included in the recommendation is a call for the use of ambulatory blood pressure monitoring. It is felt that blood pressure readings in the doctor’s office may be influenced and higher due to anxiety or “white coat hypertension.” Ambulatory Blood Pressure Monitoring providing multiple readings will give you a true average systolic and diastolic reading which permits you to separate hypertensive patients requiring treatment from anxious individuals.
When evaluating a patient for hypertension we have used the 24 hour ambulatory monitor in my office practice for years. It is a traditional blood pressure cuff designed to inflate six times an hour during daytime hours and four times per hour when you go to bed. Patients are asked to shower or bathe prior to coming to the office and to limit their activities to their normal activities of daily living. The patient drops the device off 24 hours later and we connect it to our computer and print out the readings. The device produces hourly readings plus average readings. The major side effects are the inconvenience of wearing a device which inflates six times per hour. Cost has been a factor since most insurance companies have not seen the wisdom of paying for this. In my experience it allows us to classify someone as normal or normotensive and not institute treatment most of the time. Without this type of device we were dependent on looking for complications of hypertension such as changes in the arteries and veins in the eyes using the ophthalmoscope or changes on your EKG to confirm the diagnosis of hypertension. With the development of vital sign monitoring devices associated with cellphones and computer tablets it will only get easier to accurately monitor ambulatory blood pressures in the future. These devices will additionally allow us to check on whether or not our treatment is actually keeping your BP within the limits it should.
We have one monitor in the office at the current time and ask that you make an appointment to have it placed on you if you wish to be checked.
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