However, robust evidence for the routine implementation of ambulatory blood pressure monitoring as a screening tool for masked hypertension should come from randomized clinical trials that prove that the early diagnosis and treatment of masked hypertension reduce the incidence of cardiovascular complications. Such trials are needed in view of the persistence of masked hypertension. Diagram for evaluation of patients by use of office, home, and ambulatory monitoring of blood pressure.
Reproduced with permission from the study of Staessen et al. To be equitable, health insurance should provide easy access to the diagnostic procedures that allow risk stratification on the basis of blood pressure and the rational use of antihypertensive drugs.
Failure to provide adequate reimbursement for ambulatory blood pressure monitoring is in conflict with what authoritative bodies 5—8 have unequivocally recommended. From a European perspective, ambulatory blood pressure monitoring is not reimbursed in Belgium, Denmark, France, and Spain. The National Health Service in the United Kingdom provides free access to health care, including ambulatory blood pressure monitoring. Self-measurement of blood pressure is not reimbursed in any of the aforementioned countries with the exception of Denmark.
In this country, home blood pressure measurement is reimbursed on condition that hypertension is likely to be present based on office blood pressure readings at 2 or more visits and in case of resistant hypertension or large variability in the office blood pressure readings. One of us Y. This web-based system allows experts at tertiary hospitals to assist locally practicing primary care physicians with the interpretation of ambulatory blood pressure recordings. Several studies addressed the cost-effectiveness of ambulatory blood pressure monitoring.
Originally, the idea was put forward that out-of-the-office treatment would reduce health care costs mainly by avoiding antihypertensive drug treatment in white-coat hypertensive patients.
Hypertension articles: The New England Journal of Medicine
Lovibond et al. Ambulatory monitoring was the most cost-effective strategy for the diagnosis of hypertension for women and men of all ages. These findings were robust when assessed with a wide range of deterministic sensitivity analyses around the base case, but was sensitive if home monitoring was judged to have equal test performance to ambulatory monitoring. The take-home message of this review is that ambulatory blood pressure monitoring is the state-of-the-art technique of blood pressure measurement and is indispensable for the diagnosis of hypertension and for the decision to initiate or adjust antihypertensive drug treatment.
In an era, in which the cost for the equipment required for ambulatory monitoring is decreasing, health care providers should facilitate a generalized access to this state-of-the-art technology without limitations in terms of the frequency of the recordings. Manufacturers might support this effort by designing versatile devices that can be used for all types of blood pressure measurement and by considering market size rather than profit margins per single device sold.
The only provision on which one should never compromise is that physicians and nurses, be it in primary or specialized care, have to prove that they have acquired the skills necessary for understanding the principles of blood pressure measurement, cuff fitting, monitor function and analysis, and interpretation of ambulatory blood pressure recordings.
The funding source had no role in writing this review. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search.
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Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Oxford Academic. Google Scholar. Yan Li. Azusa Hara. Kei Asayama. Eamon Dolan. Correspondence: Jan A. Staessen jan. Cite Citation. Permissions Icon Permissions.
Abstract The rational management of hypertension HT inevitably starts with accurate measurement of blood pressure BP. Table 1. Open in new tab.
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Table 2. Proposal for outcome-driven reference values for ambulatory blood pressure measurement. Open in new tab Download slide. Search ADS. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, a systematic analysis for the Global Burden of Disease Study Screening for high blood pressure in adults: U.
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Are published characteristics of the ambulatory blood pressure generalizable to rural Chinese? The JingNing population study. Prediction of the actual awake and asleep blood pressures by various methods of 24 h pressure analysis.
New study finds both components of blood pressure predict heart attack, stroke risk
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Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study. Hypertension management in managed care: the role of home blood pressure monitoring. Home self blood pressure measurement in general practice. Self-measurement for the Assessment of the Response to Trandolapril.