What is Ambulatory Blood Pressure Monitoring?

Ambulatory blood pressure monitoring (ABPM) is a useful technique to see if someone has "white coat hypertension" or adequate control of high blood pressure under treatment.  

Recall that white coat hypertension is when you have high blood pressures in the doctor's office (over 140/90 mmHg) but low pressures elsewhere, such as at work or home.  White coat hypertension does not require treatment.  

Sometimes I see patients I'm treating for high blood pressure who are not responding as expected to drug therapy.  I'm prescribing more and more drugs, the pateint is taking them, but the pressure just isn't coming down.  This is "resistant hypertension."  Many people with resistant hypertension acually have normal pressures by APBM.

These situations can be clarified with ambulatory blood pressure monitoring.  The patient wears a blood pressure monitor for 24-48 hours.  The automated device checks and records a blood pressure reading every 15-30 minutes, less often during sleep. If average pressures are under 135/85, you're doing OK as is: no need to start or intensify treatment.  

Unfortunately, some health insurers don't pay for ABPM.  The doctor has to pay $5,000-6,000 to acquire the device and software, so the office must charge $200-300 or more to defray expenses.

The low-tech alternative is to check blood pressure youself outside the doctor's office, over time, under various circumstances.  Review my post on getting an accurate reading.  Many pharmacies have installed free automated blood pressure monitors.  Who knows if they are accurate?  Some fire stations and EMS stations will check your blood pressure as a public service.  Or you can buy an automated pressure monitor for about $50 (US).  If so, have your doctor check it for accuracy at least once, if not periodically.  If your blood pressure averages under 135/85, be happy.  Even better is 120/80.

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.