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View Public Comments for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2)

Commenter:
Byrd, James Brian
Title:
Assistant Professor of Internal Medicine
Organization:
University of Michigan Medical School
Date:
10/14/2018
Comment:

Ambulatory blood pressure monitoring (ABPM) is the most accurate way to measure blood pressure, as demonstrated in many studies over several decades. [1]

This fact has been recognized by the United States Preventive Services Task Force (USPSTF), who issued a draft recommendation that ABPM be used to confirm elevated blood pressure:

"The Task Force recommends screening for high blood pressure in adults age 18 years and older. Ambulatory blood pressure monitoring is recommended to confirm high blood pressure before the diagnosis of hypertension, except in cases for which immediate initiation of therapy is necessary. Grade A" [2]

USPSTF received justified complaints that the test is not properly reimbursed and is thus poorly available to clinicians, leading the USPSTF to soften their recommendation without changing their opinion about the value of ABPM. [3] The UK is well ahead of the US in this regard, having recommended ABPM for routine use in confirming hypertension years in 2011. [4] The United States is falling behind its contemporaries.

The time has come to bring reimbursement in line with the evidence that ABPM is the most accurate method for measuring blood pressure. It is well known that office blood pressures are routinely performed in poor fashion. If accurate diagnosis of hypertension, the leading risk factor for death and disability around the globe, is not a public health priority, what is?

References:

1. http://annals.org/aim/fullarticle/2456129/screening-high-blood-pressure-adults-u-s-preventive-services-task
2. https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/1836
3. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening
4. https://www.nice.org.uk/guidance/cg127/chapter/1-guidance

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