Chester County Medicine Winter 2019 - 14

www.CHESTERCMS.org

24-Hour Ambulatory
Blood Pressure Measurement
(ABPM):
A Transformative Approach to
Blood Pressure Diagnosis and Treatment
BY MICHAEL LATTANZIO, DO

24-hour Ambulatory Blood Pressure Monitoring
or ABPM is a valuable tool for the management
of the patient with hypertension (HTN). For the
ABPM test, the patient is fitted with a specialized,
blood pressure measuring device that records the
blood pressure over a full 24-hour period. The BP
measuring intervals are every 20 minutes during the
daytime and every 40 minutes during the night. The
BP data is recorded and plotted against time. The
data is analyzed by a trained specialist and interpretations can be
used to guide BP treatment strategies.
ABPM is the gold standard for detecting hypertension and/or
confirming hypertension. Since blood pressure is a highly variable
target, physicians are often forced to make decisions to initiate
anti-hypertensive therapies based on incomplete and sometimes,
contradictory BP data. ABPM allows physicians to confidently
confirm, or, alternatively, exclude the diagnosis of hypertension.
It also provides useful data on the efficacy of anti-hypertensive
treatments for the individuals with existing HTN.
ABPM is the gold standard for excluding white coat HTN
(elevated BP in the office, but normal BP out-of-the office).
ABPM is also excellent at detecting masked HTN (normal office
BP, but elevated out-of-the office BP). Masked HTN (essentially
the inverse of white coat HTN) carries a significant risk of CV
disease and should be considered in individuals with signs of end
organ damage (LVH, proteinuria, CKD) who DO NOT have
elevated BP in the office.
14 CHESTER COUNT Y Medicine | WINTER 2019

ABPM provides daytime, nighttime, and 24-hour
BP data. Additionally, ABPM provides characterization
of nocturnal BP as either dipping or non-dipping.
Dipping status means that BP drops from daytime to
nighttime by greater than 10%. This phenomenon is
normal. Conversely, non-dippers do not experience
>10% reduction in BP from daytime to nighttime.
Non-dippers have a higher risk of cardiovascular disease
compared to dippers.
Due to ABPM, new categories of hypertension came into
existence that were previously not identifiable. For instance,
isolated nocturnal HTN occurs when individuals have normal
daytime BP, but have elevation of BP at night. Isolated nocturnal
HTN carries a similar risk of CV disease to sustained HTN.
ABPM has led to the concept of chronotherapy, which is adjusting
the timing of BP medication dosing based on an individual's
circadian pattern of blood pressure.
The US Preventative Services Task Force (USPSTF) now
considers ABPM as the reference standard for confirming
the diagnosis of HTN. Unfortunately, ABPM remains an
underutilized tool in the management of HTN. Establishing the
blood pressure phenotype through ABPM aids in determining
long-term CV risk, treatment success, and response to therapy.
Blood pressure management through analysis of diurnal blood
pressure patterns is a transformative approach. If you are
interested in scheduling or referring patients for ABPM, please
contact my office at (610) 524-3703.


http://www.chestercms.org

Chester County Medicine Winter 2019

Table of Contents for the Digital Edition of Chester County Medicine Winter 2019

Chester County Medicine Winter 2019 - 1
Chester County Medicine Winter 2019 - 2
Chester County Medicine Winter 2019 - 3
Chester County Medicine Winter 2019 - 4
Chester County Medicine Winter 2019 - 5
Chester County Medicine Winter 2019 - 6
Chester County Medicine Winter 2019 - 7
Chester County Medicine Winter 2019 - 8
Chester County Medicine Winter 2019 - 9
Chester County Medicine Winter 2019 - 10
Chester County Medicine Winter 2019 - 11
Chester County Medicine Winter 2019 - 12
Chester County Medicine Winter 2019 - 13
Chester County Medicine Winter 2019 - 14
Chester County Medicine Winter 2019 - 15
Chester County Medicine Winter 2019 - 16
Chester County Medicine Winter 2019 - 17
Chester County Medicine Winter 2019 - 18
Chester County Medicine Winter 2019 - 19
Chester County Medicine Winter 2019 - 20
Chester County Medicine Winter 2019 - 21
Chester County Medicine Winter 2019 - 22
Chester County Medicine Winter 2019 - 23
Chester County Medicine Winter 2019 - 24
Chester County Medicine Winter 2019 - 25
Chester County Medicine Winter 2019 - 26
Chester County Medicine Winter 2019 - 27
Chester County Medicine Winter 2019 - 28
Chester County Medicine Winter 2019 - 29
Chester County Medicine Winter 2019 - 30
Chester County Medicine Winter 2019 - 31
Chester County Medicine Winter 2019 - 32
Chester County Medicine Winter 2019 - 33
Chester County Medicine Winter 2019 - 34
Chester County Medicine Winter 2019 - 35
Chester County Medicine Winter 2019 - 36
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSummer2021
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSpring2021
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineWinter2021
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSummer2020
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSpring2020
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineWinter2020
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineFall2019
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSummer2019
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSpring2019
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineWinter2019
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineFall2018
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSUMMER2018
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineSpring2018
https://www.nxtbook.com/hoffmann/CCMSMedicine/ChesterCountyMedicineWinter2018
https://www.nxtbook.com/hoffmann/CCMSMedicine/CCMSMedicineFall2017
https://www.nxtbook.com/hoffmann/CCMSMedicine/CCMSMedicineSummer2017
https://www.nxtbook.com/hoffmann/CCMSMedicine/CCMSMedicineSpring2017
https://www.nxtbook.com/hoffmann/CCMSMedicine/CCMSMedicineWinter2017
https://www.nxtbookmedia.com