Advice from the BP Measurement Experts
Blood Pressure Basics
Taking a patient’s blood pressure has become a routine practice for medical staff. Unfortunately, training in this area is often met with a very high-level overview and is sometimes neglected in regards to the overall mechanics of manual or automated methods in accurate blood pressure measurement techniques.
Research has proven that ambulatory blood pressure monitoring (ABPM) is the best way to determine true blood pressure available to physicians today. Results from an ABPM device will always 1 provide a level of insight unavailable with other forms of blood pressure measurement. However, there are eight situations in which ABPM is especially useful in providing accurate readings to properly diagnose hypertension.
A blood pressure check is one of the first procedures done when you go to the doctor. So it should be no surprise that your veterinarian will likely check your pet’s blood pressure, too!
It is becoming more and more common for vets to regularly check blood pressure at every checkup. However, many pet owners do not realize that their pet’s blood pressure is constantly changing in response to many factors. Being aware of these factors and ensuring that your pet is comfortable in its environment will help the vet to get the most accurate blood pressure reading. Here is a list of 5 factors that may cause significant changes in your pet’s blood pressure:
According to the Centers for Disease Control and Prevention (CDC), nearly 70 million American adults have high blood pressure—that’s 1 in every 3 adults. More alarming is that only about half (52%) of people with high blood pressure have their condition under control.
With those overwhelming numbers, it goes without saying that raising awareness about how to reduce hypertension – with or without medication – is critical.
How Low Should Blood Pressure Go?
When it comes to blood pressure guidelines, it’s a question cardiologists have puzzled over for years – just how low should blood pressure go? Well, according to articles released by nearly every major news outlet, including The New York Times, US News & World Report, FOX News and NBC News, federal health officials have declared they have “potentially lifesaving information” as a result of a recent major study – one that they are ending a year early because it has already conclusively answered this question.
The April 2015 edition of Cardiology Today includes an interesting article – “New Hypertension Recommendations Anticipated in 2016” - stating that the American Heart Association (AHA) and the American College of Cardiology (ACC), in collaboration with nine other medical societies, will be releasing new hypertension guidelines that will serve as an update to those released by the Seventh Joint National Committee (JNC 7) in 2003.
But, wait…weren’t updated guidelines already published back in 2013? As a matter of fact, they were!
According to the Centers for Disease Control and Prevention, 67 million American adults (31%) have high blood pressure – that’s 1 out of every 3 adults. Depending upon the severity of the condition, typically diagnosed by in-office BP measurements, blood pressure medication and/or lifestyle modifications may be prescribed.
Although in-office BP measurements are typically used to diagnose hypertension, several studies have shown that other diagnostic options are far more reliable - specifically, the use of a 24-hour, ambulatory blood pressure monitoring device (ABPM).
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:
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.
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.
In 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).
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.
Ambulatory 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.
Just 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).
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.
Is 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.
Though 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.'"
This 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.
The 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.