PharmD, AHSCP-Certified Hypertension Clinician
Oklahoma Heart Hospital
ABPM is critically important to appropriate management of a wide variety of patients. White coat hypertension is only one subset of these patients. ABPM also helps resolve other discrepancies between home and office blood pressures, such as masked hypertension, labile/highly variable blood pressure, or significant circadian fluctuations in BP. For patients who do have significant variability, pairing ABPM with a diary of symptoms and activities can help identify triggers for high BP. It can also help clarify whether patient complaints of dizziness or lightheadedness are caused by intermittent hypotension or from another unrelated cause. ABPM can help optimize dosage timing for BP medications as well. In summary, there is a wide variety of patient presentations that derive significant benefit from the information provided by ABPM, and I do not believe that restricting it to a predefined subset of hypertensive patients is in the best interest of Medicare beneficiaries.