When I meet a new patient I spend 90 minutes with them, piecing together an extensive timeline, working decade by decade to create a thorough personal history, both generational and environmental. It’s the first step in developing a holistic view of the patient. The next step is testing — looking for the normal, the abnormal and the path toward prolonged health and vital aging.
This year, I expanded my offerings to include new methods of health assessment, bringing in tools that screen for and monitor biomarkers of health and risk of disease. In the weeks to come, I will be sharing information on the office’s new technology. I hope that you, too, will recognize the importance of wellness through prevention and not wait until you are “sick enough” to take steps toward living optimally.
24-Hour Blood Pressure Monitoring
Hypertension is a significant contributor to disease and death in the United States and is the number one risk factor for cardiovascular disease worldwide. The condition is treatable and is often overlooked or neglected when it comes to cardiovascular disease. Recognizing and diagnosing high blood pressure early can delay the onset of cardiovascular disease, namely heart attack, stroke, heart failure and vascular dementia.
Accurately diagnosing hypertension is important and can often be complicated by various factors, such as caffeine, nicotine, stress, physical activity, medication, pain and anxiety. “White coat syndrome,” which applies to patients with elevated blood pressure readings in the doctor’s office, is an example of when it is difficult to obtain an accurate diagnosis. While patients with this syndrome are still at risk for cardiovascular disease, they may also tend to be overtreated. Others with “masked hypertension” have normal blood pressure readings at the doctor’s office but elevated readings otherwise, which tend to result in undertreatment. Estimates show that blood pressure readings taken in the doctors’ office misdiagnose hypertension 30 percent of the time, and that measurements taken at home do not offer accurate results either.
Currently, 24-hour blood pressure monitoring is considered the most accurate confirmatory test for hypertension. The United State Preventive Task Force (USPTF) considers 24-hour blood pressure monitoring the gold standard for diagnosis, and the United Kingdom has adopted this tool in primary care as its method to accurately diagnose hypertension. The USPTF recommends 24-hour ambulatory screening yearly to those who are at high risk and every three to five years in normal-risk adults.
I recommend 24-hour blood pressure monitoring to patients who:
• experience high blood pressure readings in the doctor’s office
• are over 40 years old and at risk for hypertension and cardiovascular disease
• are having difficulty regulating blood pressure
The monitor reads a patient’s blood pressure every 30 minutes while awake and hourly while sleeping, measuring if a patient’s blood pressure dips at night, as it should. Those who do not experience a dip in blood pressure are experiencing nocturnal hypertension and are thought to be at increased risk for cardiovascular complications and disease. For those who are having trouble getting their blood pressure under control, the 24-hour blood pressure monitor reports patterns and variations in hypertensive load, which give physicians a better understanding of necessary treatment. Those with wide swings (more variability), may be at risk of developing hypertensive disease, atrial fibrillation, cardiovascular disease and cognitive decline, and have a greater risk of overall mortality.
The procedure for 24-hour blood pressure monitoring is simple: following an approximately 30-minute instructional visit, patients leave my office wearing the device and only remove it for showering/bathing and strenuous exercise. The following day, the device is brought back to the office, where we download the data and print a report for the patient and physician to review.
As nearly 80 million Americans have high blood pressure and it is estimated that nearly 20 percent of those are unaware of their condition and not receiving treatment, an accurate and early diagnosis is key to moving forward with regulation and decreased cardiovascular disease and mortality.
American Heart Association News, Task force says 24-hour monitoring best at confirming high blood pressure diagnosis, American Heart Association/2015
Banegas MD, Jose R., de la Cruz, M.SC., Juan J., de la Sierra MD, Alejandro, et al., Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality, The New England Journal of Medicine/2018
Department of Nephrology, School of Medicine, Ankara University, Ankara, Turkey, Which out-of-office measurement technique should be used for diagnosing hypertension in prehypertensives?, Journal of Human Hypertension/2019
Head, Geoffrey, Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension, American Heart Association Journal/2014
Mandas MD, Antonella, Scuteri MD, Angelo, The hidden treasure of 24-hours ambulatory blood pressure monitoring—Assessing BP variability, The Journal of Clinical Hypertension/2019
U.S. Preventive Services Task Force, Final Recommendation Statement: High Blood Pressure in Adults: Screening, U.S. Preventive Services/2019