What is ABPM?
ABPM, or Ambulatory Blood Pressure Monitoring, allows doctors to assess blood pressure during routine daily living, rather than at a doctor’s office. It has allowed doctors to determine whether a patient has hypertension, when previous readings in the doctor’s office have been highly variable or perplexing. Additionally, ABPM has been more accurate than clinical and home monitoring in diagnosing hypertension, particularly in identifying “white coat” or “masked” hypertension – when blood pressure readings at the doctor’s office are different than they are in other settings, such as your home.
What is Central Blood Pressure?
In recent years, Central Blood Pressure monitoring has proven to be the most accurate in diagnosing hypertension. Central Blood Pressure (CBP) is the pressure of blood leaving the aorta, circulating out of the body through the left ventricle of the heart. Blood pressure will not be consistent throughout the body and has a high variability of change due to age, arterial stiffness, and/or blockages. Studies have shown that basing treatment decisions on Central Blood Pressure is likely to lead to important conclusions on the management and diagnosis of hypertension.
Why is Central Blood Pressure Important?
Central Blood Pressure has been a critical breakthrough in blood pressure monitoring because it is a better risk indicator for hypertension than previous methods. While conventional blood pressure is measured in the arm, called Peripheral Blood Pressure, Central Blood Pressure measures the pressure in the aorta near the heart. As “heart attacks” occur in the heart and not the arm, this is a great example of why Central Blood Pressure is able to give more accurate readings. Recording accurate Central Blood Pressure readings will allow for better and more accurate patient care, as well as the reduction of misdiagnosing patients.
Many studies have shown that CBP is a better predictor of future cardiovascular events than Peripheral Blood Pressure. The recent breakthrough in the determination that Central Blood Pressure is the most effective way of measuring the risk of hypertension in an individual has been utilized by a new product called the Mobil-o-graph. The Mobil-o-graph includes occasional, interventional, and 24-hour blood pressure measurements when monitoring a patient.
Why is CBP/ABPM more effective than a typical clinical setting?
Identifying or ruling out hypertension requires repeated measurements over an extended period, which includes testing on many different days, as well as over the course of different times of day. In addition, resting blood pressure requires at least two to three different measurements and demands you rest for five minutes before the test.
While devices that use a blood pressure arm cuff to measure arm pressure create a “Central Blood Pressure,” the they ignore individual variations in downstream arteries. Peripheral Blood Pressure is also generally higher than CBP, and the degree to which it is higher can be determined by the stiffness of arteries.
On the other hand, ABPM allows patients to wear a blood pressure monitor for 24 hours, while they go about their daily routine. A diagnosis can be determined after just one examination because ABPM provides the best measure of actual blood pressure.
What other benefits does ABPM offer?
ABPM offers a variety of benefits. It can help identify both white coat hypertension and masked hypertension, which are not able to be diagnosed through routine medical exams. In addition, ABPM allows doctors to learn about their patients’ early morning blood pressure, as well as their day-night rhythm. Over a 24-hour period, blood pressure has a characteristic day-night rhythm. The absence of a day-night rhythm may be an indicator of secondary hypertension – high blood pressure caused by another medical condition.
How do I know which measurement system is for me?
The Mobil-o-graph will include at least three different cuff sizes, ranging from pediatric to obese patients, allowing for more accurate readings. Additionally, environmentally friendly rechargeable battery systems are useful for reducing running costs. The analysis software should also meet methodological requirements for risk screening, diagnosis, and monitoring of treatment. Furthermore, reports for patients should facilitate patient management and on-site training/training for medical assistants should always be available.
How can physicians reimburse 24-hour CBP/ABPM services?
The reimbursement process will be in accordance with country-specific regulations. ABPM provides details on conventional blood pressure measurement and may be offered as part of a preventive program. Additionally, Current Procedural Terminology (CPT) codes offer physicians the ability to speak a common language in the procedures they provide for patients. The codes are developed and maintained by the American Medical Association and are used by Centers for Medicare and Medicaid (CMS) for reimbursement to Medicare providers. Many, if not all, insurance companies require CPT codes for compensation, so this is essential to be compensated for medical procedures done.
Insurance companies are willing to pay for the health updates of potential and current customers, as they can view and interpret a more accurate screenshot of an individual’s health. The Mobil-o-graph mentioned earlier is eligible for four different CPT code referrals. The fact that this unit comes equipped with CPT codes is essential in the field as ABPM units alone generally don’t allow for reimbursement plans. It is also known that CBP/ABPM services are the cheapest way in diagnosing hypertension, which is helpful for insurance companies.
Sources
https://www.verywellhealth.com/ambulatory-blood-pressure-monitoring-1746062
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155427/
https://www.tandfonline.com/doi/pdf/10.1586/erc.10.44
