Round-the-clock monitoring: bringing home the blood pressure cuff

We spend the early moments of most healthcare visits sitting with an arm in a blood pressure cuff, waiting for the monitor to take its measurement so that the cuff will relax and let our arm “breathe” again.

by Greeshma Somashekar   

            We spend the early moments of most healthcare visits sitting with an arm in a blood pressure cuff, waiting for the monitor to take its measurement so that the cuff will relax and let our arm “breathe” again. Taking a blood pressure reading in the clinic is the standard practice to screen for hypertension. Prevention experts now recommend that patients with elevated blood pressure in the clinic have additional measurements outside the clinic setting, ideally with a 24-hour ambulatory blood pressure monitor, to confirm hypertension.

            One of the most common conditions seen in patients is hypertension, or high blood pressure, which affects 1 in 3 American adults and contributes to ~1000 deaths every day. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps. If this force rises and remains high, it can contribute to adverse health issues over time. People with hypertension are at higher risk for heart disease and stroke, the first and fourth leading causes of death in the United States. The Centers for Disease Control estimates the national cost of hypertension to be $47.5 billion in direct medical expenses.

            Given the increasing prevalence of hypertension and its associated risks, we must get blood pressure measurement right. According to the US Preventive Services Task Force (USPSTF), 15 to 30 percent of adults have “white coat hypertension” – high blood pressure appearing only at the doctor’s office when medical providers are present. This finding may lead to the over treatment of falsely diagnosed hypertension.

            A single blood pressure measurement is never used to diagnose hypertension. In addition to repeated measurements taken in the office setting, the latest USPSTF recommendation is that people with elevated clinic measurements have outside readings to confirm hypertension. The ideal method is ambulatory blood pressure monitoring, where patients are fitted with a device that takes intermittent blood pressure readings for 24 hours.

            In order to better understand 24-hour ambulatory blood pressure monitoring, we spoke with two former research study participants about their experiences with the device. The process begins with being fitted with the cuff and receiving a detailed explanation of what will happen during the 24 hours. The blood pressure cuff itself is made of durable fabric that is machine washable. A thin cord connects the cuff to a wallet-sized portable monitor that can be clipped to the provided waist harness or belt. “I wore it to work and hardly noticed it, to be honest,” Carol Townsend said. The whole apparatus is concealable under a shirt or jacket.

            Measurements are typically taken every 20-30 minutes during the day and every 30-60 minutes during sleep to provide a reliable picture of an individual’s blood pressure over time. Patients are advised to try and relax their arm when the cuff tightens because the device may repeat the measurement a few moments later if there isn’t a good measurement the first time. “Even though I’m not a heavy sleeper, it didn’t bother me at night,” noted John O’Donnell, who has worn the 24-hour monitor twice. He suggests planning for a day when you won’t need to be very physical.   At the end of the 24 hours, patients and their clinicians are provided a detailed report of their blood pressure measurements over the day and night, along with average values. Seeing the spikes in one’s blood pressure may motivate behavioral changes that correspond to certain times in the day. For someone looking to associate blood pressure readings with daily activities, “it’s important to keep a simple journal of what you’re doing during those 24 hours”, O’Donnell stated.

            Ambulatory blood pressure monitoring at UNC Family Medicine and elsewhere is an opportunity for people to better understand their blood pressure pattern. Helpful information can be gleaned from a 24-hour report that can’t be assessed with a one-time measurement. Townsend was motivated to have ambulatory BP monitoring because of her family history. “Both my parents had high blood pressure, and my father died of a heart attack, so I want to make sure I get all the information I can,” she said.

            “I would rather be offered the 24-hour monitoring than having a physician assume that I wouldn’t want it because it might be inconvenient for me,” O’Donnell reported. This monitoring strategy can be used to accurately diagnose high blood pressure, reducing the over treatment of white coat hypertension.

Interested in Ambulatory Blood Pressure Monitoring (ABPM)? Ask your doctor about the benefits of ABPM. Call 984-974-0210 to make an appointment with your doctor.

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