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Blood Pressure Screenings

The in-office versus at-home debate.

The consensus among healthcare professionals is that ambulatory blood pressure screenings lead to reliable diagnoses. Ambulatory screenings can be taken when patients are in motion, whether exercising or performing functions of daily living, rather than at single resting moments. For example, a patient could have a low blood pressure reading sitting in a doctor's office. But when the same individual is pushing a grocery cart at the supermarket, those critical numbers may go up, revealing a clearer picture of hypertension risk.

The question then is how to encourage this type of screening and implement the test in an affordable way.

Published in the Annals of Internal Medicine, a recommendation by The U.S. Preventive Services Task Force (USPSTF), suggests  ambulatory blood pressure monitoring (ABPM) be used to confirm diagnosis of hypertension measured in-office. However, the Task Force also acknowledged current barriers to implementation of its recommendation: availability and affordability.

American Heart Association President Elliot Antman, MD, of Brigham and Women's Hospital and Harvard University, told MedPage Today that ambulatory screenings have been hard to implement in the past because of a lack of equipment. However, the recent developments in smart-device technology are making it easier for patients to keep track of their blood pressure themselves and send the readings to their doctors remotely.

As of last January, nearly 46 million U.S. smartphone users used a fitness and health app which was an 18% increase from smartphone users using health apps just the year before, according to data collected from The Nielsen Health and Wellness Study.

American College of Cardiology President-elect Kim A. Williams Sr., MD, chief of cardiology at Rush University Medical Center in Chicago encourages this type of ambulatory screening. "In my experience it fully engages patients in the control of their blood pressure," she said via news release from MedPage Today. "When you measure it, you don't ignore it."

The American Heart Association recommends a regular blood pressure screening every two years starting at age 20 with a target measure of less than 120/88 mm Hg.

Meanwhile, the Task Force recommends that people 40 and over, as well as higher-risk groups, be re-screened every year after a normal blood pressure finding. This is a major shift from the previous suggested re-screening interval of every two to five years.

While challenges remain - including a lack of ambulatory monitors in many providers' offices, ultimately there's a hope from clinicians, including Antman, that the Task Force's recommendation could make ambulatory screenings more readily available in-office. He commented that the guidelines, "if put into play, will instill an expectation that every physician's office, every hypertension specialist's office, will have one of these devices to confirm the diagnosis of hypertension."

He also expects a revised definition for hypertension, making it even more important for these screening guidelines to be updated and improved now.

 Chelsea Lacey-Mabe is a staff writer at ADVANCE. Contact: clacey-mabe@advanceweb.com


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