Sunday, June 30, 2013

Blood Pressure tracking is best done outside of the doctor's office

Thursday, June 27, 2013
The Record
Your name has been called in the doctor's office. You take a seat, roll up your sleeve, stick your arm in a cuff, squeeze, and then a nurse or doctor reads your blood pressure. It's been done this way for years.
But a growing number of medical experts say that doctors' office blood-pressure readings can be flawed when it comes to diagnosing hypertension, an often symptomless condition that affects a third of adults, and is a major risk factor for heart attack, stroke and kidney disease. According to the American Heart Association, about 20 percent of patients experience "white-coat hypertension" — high blood pressure in the doctor's office due to the anxiety of being examined. Another 30 percent may experience "masked hypertension," blood pressure readings that are normal in the doctor's office, but high during the rest of the day.
"You can't make a decision to commit someone to taking a lifetime of blood pressure medications without having good data," said Dr. David Landers, a cardiologist at Hackensack University Medical Center. "One blood pressure reading in the office is not useful. What you need is more data points."
Some doctors maintain these two devices are better at tracking hypertension: home blood pressure monitors, which have become more affordable (about $45) and accurate in recent years; and an ambulatory blood pressure monitor (ABPM), a cigarette-pack sized device worn by patients for 24 hours and prescribed by their doctors. Fitted with a microchip, it automatically records blood pressure at regular intervals.
In the United Kingdom, ABPMs are routinely used. Anyone suspected of having high blood pressure is ordered to wear an ABPM before going on medication, as recommended by the national health service. In the United States, on the other hand, ABPM is not considered standard care and thus, according to Dr. David Wild, a cardiologist at Holy Name Medical Center in Teaneck, health insurance providers won't always cover it. Medicare will cover ABPM, but only if it's suspected a patient has "white coat hypertension."
Some doctors maintain ABPM is best. By wearing it for 24 hours, patients can have their sleeping blood pressure recorded, which for a small segment of the population may be critical. On average, a person's blood pressure dips by about 10 to 20 percent during sleep. But for some this dipping does not occur, and recent studies show that this group is at very high risk for heart attack or stroke, according to Dr. Craig Bowron, a Minneapolis-based internist and medical writer.
For those already being treated for hypertension, ABPM can also be useful in monitoring how well blood pressure medicines are working throughout the day, Boron said. With this information, a doctor may want to adjust the dosage or, depending on their daily blood pressure variances, even the time a patient takes his/her medication.
"We may be misdiagnosing patients," said Wild. "We should be doing more ABPM. It's the most accurate way to diagnose hypertension."
For Landers, a home blood monitor is good enough. "It's more user-friendly," he said. Though home monitors can become obsessive. "They can make people neurotic," said Bowron, "the same way people follow the stock market's ups and downs in a day."

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