Associate Professor, Director Hypertension Section
Washington University School of Medicine, Cardiology Division
I am writing in support of Medicare coverage of ABPM for the diagnosis of hypertension. The use of ABPM for this purpose is recommended by the USPSTF as well as the 2017 ACC/AHA HTN guidelines, both based on grade A level of evidence. Ambulatory monitoring has been shown to be superior to office monitoring for making the diagnosis of HTN. Office monitoring provides a blood pressure reading at one point in town, not accounting for the fact that blood pressure fluctuates during the day and in different situations. Ambulatory monitoring better distinguish between chronic elevation of blood pressure (HTN) and white coat HTN, thus alleviating the potential for unnecessary treatment in someone with white coat HTN. Masked HTN (normal office BP readings but elevated ambulatory BP) can also be determined, which would allow for early diagnosis and treatment for patients at risk for target organ damage due to undiagnosed HTN. I would also advocate that ABPM is essential for diagnosing orthostatic hypotension and assessing the degree of labile HTN in older adults. As patients become older, blood pressure becomes more labile often resulting in nocturnal hypertension, most commonly seen in those with other co-morbidities (obstructive sleep apnea, CKD, diabetes, etc) or autonomic dysfunction. Without ABPM, the diagnosis of nocturnal HTN could not be effectively made in order to treat appropriately. Without access to ABPM, my ability to adequately diagnose HTN and treat several of it's forms is greatly hampered in my Medicare patients. Our goal in treating HTN is to reduce cardiovascular events and decrease mortality. Timely diagnosis and treatment of HTN is key, and ABPM as a tool for diagnosis is extremely important to achieve this goal. I strongly encourage you to consider coverage of ABPM for the diagnosis and management of HTN. Thank you.