Blood pressure readings may be elevated in the office setting for a variety of reasons that could lead to inaccurate assessment and overtreatment. Monitoring blood pressure at home over a 24-hour period may improve patient outcomes.
Montefiore’s new Ambulatory Blood Pressure Monitoring (ABPM) Program is helping providers diagnose hypertension, identify blood pressure patterns, such as white coat and masked hypertension, and evaluate individuals with difficult-to-control hypertension.
“As many as one-third of patients may have higher blood pressure in the office compared to the ambulatory setting,” said Molly Fisher, DO, Director of the ABPM program and nephrologist at Montefiore. Reasons for this may include anxiety or caffeine intake prior to the visit.
“In the office, we see patients at isolated time points which may not be reflective of their blood pressure most of the time,” Dr. Fisher said. “Ambulatory blood pressure monitoring provides a large amount of data on blood pressure outside of the office and ideally we would like to target our treatment to out-of-office readings.”
Performing an ABPM Study
The process is straightforward. Eligible patients are seen by a nurse and fitted with an upper arm blood pressure cuff attached to an electronic monitor the size of a deck of cards that they go home with. The monitor is programmed to check their blood pressure at 30-minute intervals throughout the day and night. The generated data report provides estimates of the patient’s 24-hour average blood pressure, including awake and nighttime average blood pressure readings.
“Blood pressure should normally decrease by 10-20 percent at night during sleep,” Dr. Fisher noted. The absence of a decrease in nighttime blood pressure may indicate increased risk for adverse cardiovascular outcomes. One advantage of ABPM, she said, is the ability to capture nighttime blood pressure readings and assess for nighttime dipping.
Consequences of uncontrolled hypertension include cardiovascular, cerebrovascular and kidney disease. Ambulatory blood pressure readings have been shown to more closely correlate with adverse clinic outcomes compared to office-based blood pressure readings.
ABPM Referrals
Since its launch in 2018, doctors in the ABPM program, run by the Department of Medicine’s Division of Nephrology, have seen more than 80 patients. Initial ABPM referrals included nephrology patients with suspected white coat hypertension or resistant hypertension and blood pressure evaluation in potential kidney donors. Blood pressure management in these populations is very important since hypertension accounts for one of the leading causes of end stage kidney disease requiring dialysis. The growing program is now available by referral from clinical providers in all specialties throughout the Montefiore Health System who may see patients with high blood pressure.
To make a referral, send message in Epic to Dr. Molly Fisher or email her at mfisher@montefiore.org.
Posted on: Tuesday, March 03, 2020