Professor of Medicine
University of Chicago Medicine
There has been a voluminous amount of good quality data published on the use of ABPM and cardiovascular risk as well as outcomes. The most striking and important paper was published this year in the New England J of Medicine by Banegas et.al. clearly showing the risk of CV events and mortality in those with masked hypertension, a diagnosis impossible to make without ABPM. These data coupled with the IOM report recommending the use of ABPM for initial screening of hypertensive patients to eliminate white coat and masked hypertension practically mandate this test. The key is reimbursement. I would propose this be handled like Holter monitors. ANyone can order then but only certified hypertension specialists should be able to read them officially and bill for them. Moreover, they should be reimbursed at a level similar to Holter monitors given the outcome data that exist. I realize CMS is interested in morbidity and not mortality data in those over 65 and I'm sure this data must exist in this group to help you justify the cost. Putting a restriction on this test as currently present, i.e. will only pay if white coat hypertension is a diagnosis is unacceptable given what we know now. Thanks for reading this.