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Guidelines on the clinical utility of ambulatory blood pressure
1Section of Hypertension and Clinical Pharmacology, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
Insights
Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for hypertension management due to its proven link to cardiovascular events. However, widespread clinical adoption is hindered by economic factors, primarily lack of reimbursement.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Practice
Background:
- Ambulatory blood pressure monitoring (ABPM) has evolved from a research tool to a clinically relevant technology.
- Numerous guidelines now support ABPM for hypertension management, reflecting growing evidence of its importance.
- Increasing data indicates ambulatory blood pressure is an independent risk factor for cardiovascular events.
Purpose of the Study:
- To review the transition of ABPM into clinical practice.
- To highlight the role of ABPM in hypertension management.
- To discuss barriers to the widespread adoption of ABPM.
Main Methods:
- Review of national working committee consensus documents and clinical guidelines.
- Analysis of the evidence supporting ABPM's role in predicting cardiovascular events.
- Examination of economic factors influencing ABPM implementation.
Main Results:
- Multiple guidelines now endorse ABPM for selected patients and, more recently, for wider clinical use.
- Evidence confirms ambulatory blood pressure as an independent cardiovascular risk factor.
- Lack of reimbursement is a significant barrier to ABPM's growth in clinical practice.
Conclusions:
- ABPM is a valuable tool for hypertension management with established clinical applications.
- Growing evidence supports broader use of ABPM in clinical practice.
- Economic constraints, particularly reimbursement issues, limit the widespread adoption of ABPM.
Abstract:
Ambulatory blood pressure monitoring has made the transition from a technology used almost exclusively in clinical research to one that has numerous applications for clinical practice and the management of hypertension. During the past 8 years, many national working committees have published consensus documents or clinical guidelines on ambulatory blood pressure monitoring in practice. Most of these guidelines, including those published by the American College of Cardiology (1994), the American Society of Hypertension (1996), and the USA's Joint National Committee (1997) support the use of ambulatory blood pressure monitoring for selected patients. Because of increasing evidence that ambulatory blood pressure is an independent risk factor for cardiovascular events, some of the more recent consensus documents have endorsed the more widespread use of ambulatory blood pressure monitoring in clinical practice. However, the growth of ambulatory blood pressure monitoring in practice has generally been limited by the state of the health economy, including lack of reimbursement for the costs of the procedure in most countries.