Feature Article

Ambulatory blood pressure monitoring: its place in general practice

Feature Article

Ambulatory blood pressure monitoring: its place in general practice

Geoffrey A. Head

Figures

© GEOFFREY A. HEAD. MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY AND TO SHOW A PERSON BEING ACTIVE WHILE WEARING THE DEVICE. NORMALLY THE CUFF IS WORN UNDER CLOTHING. SEE TEXT REFERENCES FOR CORRECT FITTING INSTRUCTIONS.
© GEOFFREY A. HEAD. MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY AND TO SHOW A PERSON BEING ACTIVE WHILE WEARING THE DEVICE. NORMALLY THE CUFF IS WORN UNDER CLOTHING. SEE TEXT REFERENCES FOR CORRECT FITTING INSTRUCTIONS.

Abstract

With the listing of 24-hour ambulatory blood pressure monitoring as Medicare item number 11607 for the diagnosis of hypertension, it is timely to reassess its place in general practice.

Key Points

  • Ambulatory blood pressure monitoring (ABPM) is the gold standard method to measure blood pressure (BP). It is highly accurate and able to determine the entire 24-hour BP profile of a patient during a typical day and night.
  • Nocturnal BP measurements are the best predictors of future cardiovascular events.
  • ABPM is the best method to diagnose hypertension and can be used for long-term monitoring of a patient’s BP profile.
  • ABPM is the most accurate predictor of future cardiovascular events or end organ damage compared with clinic or home BP assessments.
  • ABPM limits considerably hypertension misdiagnosis (white-coat or masked hypertension), which can occur with casual clinic BP measurements.
  • The hypertension threshold for daytime ABPM is 135/85mmHg and night time, 120/70mmHg.
  • ABPM is now available as Medicare rebate item number 11607 for the diagnosis of hypertension in previously untreated patients with grade 1 or grade 2 hypertension as recorded during clinic measurements.
  • Setting up an ABPM service in general practice needs initial investment in equipment and training of staff or a practitioner to perform the recording and interpret result correctly.
  • Only ABPM devices listed on the Australian Register of Therapeutic Goods should be used. They should also be validated and calibrated at regular intervals.
  • ABPM should be used in conjunction with clinic and home BP measurements.