Does 24-Hour Ambulatory BP Monitoring Represent an Opportunity?

A recent study in the New England Journal of Medicine (NEJM) highlighted the value of ambulatory blood pressure (BP) monitoring over in-clinic assessments.¹ Essentially, researchers in Spain ran a study from 2004 to 2014 in which almost 64,000 patients were assessed to determine whether 24-hour ambulatory BP data compared with clinic measurements had any significant difference in predicting all-cause and cardiovascular mortality. No study in the past has been this large or run as long when asking this question, but other studies published before and during this study looked at the same question, and the results indicated that ambulatory measurements are valuable.

What this study adds to the literature is that not only are ambulatory measurements a better predictor of mortality, even patients with masked or white coat hypertension were at higher risk of death than those with sustained hypertension. That is a shock, as many clinicians may not have been as aggressive with treatment in such populations, which may have led to less treatment, predisposing those patients to adverse outcomes.

But the concept of 24-hour BP measurement opens up other items for discussion. One is the use of technology to accomplish this goal. When the study launched in 2004, what was used to conduct 24-hour BP measurements? The product was the Spacelabs model 90207 from Spacelabs Healthcare.² This product has been around for about 30 years. This is an excellent example of a study that used a tool that became outdated over the course of the trial. For starters, the device is worn on the arm and waist, and it looks big and bulky. One of the advertisements found online has a guy holding up a CD. This really demonstrates how far the field of digital health has progressed.

Take, for instance, the multiple Bluetooth-enabled devices that have now entered the market. We have reached the point of continuous blood glucose monitoring, and several companies are pushing for the same blood pressure with new devices. Or consider Omron, which is a popular home BP device sold in pharmacies. Omron has been working on continuous BP devices and is even looking to develop a BP watch that can be worn on the wrist called the Project Zero 2.0 Wrist Blood Pressure Monitor.³

With increasing data indicating that continual ambulatory monitoring is a worthwhile endeavor for monitoring, it poses the question of how to go about it. The advent of mobile health technology really opens up a possibility where patients could have their BP and heart rates monitored daily using a device worn innocuously on their wrists. But then it raises the issue of what to do about these data. Take, for instance, the recent study in NEJM highlighting the intervention of pharmacists with collaborative practice working out of barbershops helping to improve BP control. Coupling continuous BP monitoring and such collaborative practice could empower pharmacists to be helpful in monitoring and managing BP at the community level. Again, being able to bill to provide such services is key, as is a plan on how to employ it into the workflow.

References

1. Banegas JR, Ruilope LM, de la Sierra A, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378(16):1509-1520.

doi: 10.1056/NEJMoa1712231.

2. Spacelabs Healthcare. 90207/90217 Ambulatory Blood Pressure Systems. spacelabshealthcare.com/wp-content/uploads/2013/09/ABP-EN.pdf. Accessed April 30, 2018.

3. Omron Health. Going for Zero. omronhealthcare.com/generation-zero/. Accessed April 30, 2018.