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

Basile, Jan
Professor of medicine
Medical University of South Carolina
The most recent 2017 ACC/AHA hypertension guideline is in line with the 2011 National Institute of Clinical Excellence (NICE), the 2015 Canadian Hypertension Education Program, and the most recent 2015 US Preventive Services Task Force which recommend Ambulatory BP Monitoring (ABPM) as the definitive test for the diagnosis of hypertension. While home BP monitoring is also favored in the 2017 guideline because of its more widespread availability, home BP monitoring lacks the strength of evidence of ABPM for diagnosing both treated and untreated masked and white-coat hypertension, as well as nocturnal hypertension. Home BP monitoring, while important for the day-to-day care of the patient with hypertension, lacks the standardized methodology of ABPM and home BP monitoring is more likely to be influenced by reporting bias which influence the diagnosis of hypertension unfavorably. Furthermore, home BP monitoring is unable to detect nocturnal hypertension which may be the only phase of BP measurement which is abnormal. Until we are able to properly train and oversee the correct technique for home BP monitoring, as well as have direct computer-linked telemonitoring capability, we should insist on ABPM with its larger sample of measurements throughout the 24 hour cycle for securing the diagnosis of hypertension. Finally, as ABPM and Home measurements are in agreement only 60-70% of the time, ABPM is a technology whose time has come for prime time use to identify white-coat, masked, and nocturnal hypertension.