Implementation of Ambulatory Blood Pressure Monitoring for Hypertension Diagnosis in Primary Care

Hypertension is a significant health concern that affects 45% (108 million) of American adults, with 37 million of them having blood pressures ≥140/90. The two traditional methods of assessing and diagnosing hypertension in the primary care setting are clinic blood pressure measurement (CBPM) and home blood pressure monitoring (HBPM). Unfortunately, these methods have been found to have problematic variability, are time-consuming, and can be costly to the patient. A third method, ambulatory blood pressure monitoring (ABPM), leverages advanced technologies and provides a more accurate representation of the patient’s naturally fluctuating blood pressures throughout the day and night, detecting isolated nocturnal hypertension and nocturnal non-dipping patterns, which are stronger predictors of cardiovascular mortality and events. This evidence-based practice project was conducted at a rural family practice clinic that utilized HBPM and CBPM methods in central Virginia. The project demonstrated significant improvements in the diagnosis and management of hypertension in the clinic and has been adopted as an integral clinical practice component in the clinic. Specifically, ABPM found 38% of the participants who presented with hypertension actually did not have hypertension, thereby avoiding potential multiple clinic visits, cost burdens, and unnecessary treatments. The ABPM method also demonstrated significant improvements in the timeliness of assessment and diagnosis, providing critical diagnostic information in two to five days compared to over three weeks with the CBPM and HBPM methods. The ABPM method was well accepted by the clinic staff, with 80% of the staff questioning the accuracy and efficiency of HBPM and CBPM, preferring ABPM over other methods.