Director, Stanford Hypertension Center
Stanford University School of Medicine
Current recommendations for ambulatory blood pressure monitoring (ABPM) are clearly delineated in guidelines by the US Preventive Services Task Force in 2015 and the American Heart Association/American College of Cardiology in 2017. However, in current practice, ABPM is rarely performed in large part due to the lack of Medicare coverage for ABPM beyond the diagnosis of white coat hypertension. Expanding Medicare coverage of ABPM will advance the field of hypertension care for the following reasons:
1) ABPM can exclusively detect nocturnal hypertension and asymptomatic, paroxysmal hypertension. The importance of the former is relevant based on observational data that masked hypertension is associated with higher risk stratification than sustained hypertension (Banegas, NEJM, 2018).
2) ABPM provides a more comprehensive overview of blood pressure than a single office-based blood pressure measurement, allowing for more accurate diagnosis and management of hypertension.
3) ABPM provides an objective standard for comparison against home blood pressure measurements.
4) Expanded ABPM coverage may spur innovation in ABPM technologies that will allow for more convenient measurement of longer duration, and could accomplish for blood pressure what is currently available for heart rate monitoring (e.g. Ziopatch, Apple Watch).
Thank you for your time and attention.