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CG127 Hypertension: Professor Richard McManus discusses the use of ABPM

Professor Richard McManus, University of Birmingham, discusses the use of ambulatory blood pressure monitoring (ABPM).

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This podcast was added on 24 Aug 2011

Podcast transcript

“Hello and welcome to this podcast from NICE. Today sees the launch of updated hypertension guidelines. Joining me to discuss the update is Professor Richard McManus from the University of Birmingham.

Q1: “So Richard you were involved in the development of this updated guidance and there are a number of new recommendations, such as the use of ambulatory blood pressure monitoring (ABPM) to make a diagnosis of hypertension. Can you just explain what ambulatory blood pressure monitoring is?”

RM: “Well this is where you measure blood pressure over a 24 hour period rather than what is typically done where you measure blood pressure as a one off, say in a GP consultation.

“It uses an automatic machine which is a bit like an old fashioned Walkman that you wear on a belt and this measures the blood pressure roughly every half an hour during the day and every hour at night to give you a profile of how your blood pressure changes over a 24 hour period.”

Q2: “And so why has this been recommended? Is this more effective than talking blood pressure measurements in the clinic? Is it a more accurate way of diagnosing hypertension?”

RM: “Well blood pressure varies from minute to minute, day to day, and month to month, and we have known for a long time that blood pressure measured over 24 hours gives you a better idea of prognosis, in other words how likely someone is to have a future heart attack or stroke or serious problem like that.

“The new thing that we have done as part of this guideline is combine that evidence with evidence on how effective the different methods of blood pressure are in diagnosing hypertension, and finally combining that with the costs of all of this.

“Rather surprisingly we found that doing ABPM in the long term, looking at the lifetime of a person with raised blood pressure, is actually cheaper than doing what we are doing now.

“When we were doing this work we thought that it was quite likely that this would be better but more expensive. But it’s actually cheaper and that’s really the combination of the more effective diagnosis and the cost saving that’s driving this change in recommendation.”

Q3: “Ok, so it will help to cut down on GP time and reduce the need for repeat measurements then?”

RM: “So, I think in terms of GP time it’s not clear entirely that it will cut down on time. It certainly won’t increase time but it will mean that time is spend in different ways. t will certainly mean that diagnoses can be made quicker.

“Because it’s a more definitive test than clinic measurements, I think what it will cut down on is quite a lot of ‘while you’re hear I’ll just see what your blood pressure’ because once you have done an ambulatory blood pressure monitor and its normal than we are recommending that you probably don’t need to do that for another five years unless it’s near the threshold.

“But for most people if you have a normal ABPM level than you don’t need to keep doing clinic measurements then for perhaps five years.”

Q4: “The introduction will help to overcome what’s known as the ‘white-coat effect’ is that right?”

RM: “Yes, so the key thing with this method of diagnosing, we believe, is that it’s going to be better for patients because it’s going to make sure that those people who do have hypertension are identified and receive treatment, and those that don’t similarly don’t get unnecessary treatment.”

Q5: “Is ambulatory blood pressure monitoring suitable for all patients? Is there something else on offer if patients don’t want this?”

RM: “We think that ambulatory monitoring will take a bit of time to come in as this is quite a big change but once it comes in we think it will be appropriate for the majority of people.

“We think that perhaps in about 1 in 20 people it might not be appropriate be because it’s uncomfortable or  for other reasons.

“In cases where it is not appropriate, then home monitoring where you do readings for at least 4 days - but typically for a week where you measure your blood pressure morning and evening with a home monitor the kind of thing you can buy from your pharmacist - that would be an alternative.”

Q6: “And just finally about implementing ABPM in surgeries is this something that requires a lot of training to get practice nurses and GPs onboard or is it something that is quite straightforward and can be picked up quickly?”

RM: “Undoubtedly it will need training but it’s not rocket science, it’s reasonably straightforward. I think as part of the implementation process that GPs and nurses, perhaps more nurse to be honest than GPs,  are going to need to have training in how you do it. 

“GPs are going to need some training in how you evaluate the results of this. But it’s not too tricky. The key thing is that blood pressure measured outside of the clinic is slightly lower than blood pressure measure in the clinic and so it’s making sure that one understands this and the thresholds for this are very clearly laid out in the new guidance.”

Richard, thank you very much for your time.

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Disclaimer

This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.