Ambulatory Blood Pressure Monitoring Recommended

The results of an updated systematic review from the United States Preventive Services Task Force on the benefits and harms of high blood pressure (BP) screening in adults supported the use of ambulatory BP monitoring (ABPM) as the reference standard for confirming elevated BP screening obtained in the physician’s office [Ann Intern Med. 2014; DOI:10.732/M14-1539]. The study was funded by the Agency for Healthcare Research and Quality.

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“Our evidence supports using [ABPM] to confirm an office finding of high [BP],” said Mary Sawyers, media relations manager, Kaiser Permanente Center for Health Research, Portland, Oregon, in an interview with First Report Managed Care. “Ambulatory monitoring provides multiple measurements over time in the patient’s normal environment and during routine activities, so it is a more accurate measure and avoids the potential for overtreatment of an isolated case of high [BP] diagnosed during [an] office visit.”

Along with updating a previous systematic review on the benefits and harms of screening adults for high BP, the review summarized the evidence on intervals for rescreening as well as the diagnostic and predictive accuracy of different BP methods for cardiovascular events.

The review, conducted by Kaiser Permanente Research Affiliates Evidence-Based Practice Center, was based on fair- and good-quality trials and diagnostic accuracy and cohort studies selected from a number of research databases, including MEDLINE, PubMed, the Cochrane Central Register of Controlled Trials, and CINAHL, all of which took place before February 24, 2014. All studies were conducted with English-speaking adults.

Based on 11 studies included, the study found that ABPM monitoring predicted long-term cardiovascular events (eg, myocardial infarction and stroke) independent from BP measurements obtained in the office setting (hazard ratio [HR], 1.28-1.4).

After nonoffice confirmatory testing, the study found that 35% to 95% of persons across 27 studies with elevated BP screening remained hypertensive.

In individuals who were normotensive after confirmatory testing, cardiovascular outcomes were similar to outcomes of individuals who were normotensive at screening.

When looking at the best intervals for rescreening, the study found that based on 40 studies, the incidence of hypertension varied considerably at each yearly interval up to 6 years.

The findings further support the importance of confirmatory BP measurements whether at rescreening or initially, according to the authors.

Although the study found that office-based BP screening involving repeated measurements improved accuracy, it did not correct for isolated clinic hypertension, according to Ms. Sawyers.

The study also found that specific risk factors were associated with a higher incidence of hypertension at shorter intervals between rescreening, including persons with high-normal range BP, older age, above-normal body mass index, and for black individuals.

According to Ms. Sawyers, this finding indicates that not all individuals need the same frequency of screening because of the different incidence of hypertension based on these risk factors and that the evidence supports screening at-risk individuals more often and those at less risk less often.

Based on these results, the authors concluded, “Time and resources may be better directed toward improved measurement accuracy and timely measurement in higher-risk persons rather than measurement of all persons at every office visit.”—Mary Beth Nierengarten