Trends in ambulatory blood pressure monitoring use for confirmation or monitoring of hypertension and resistant hypertension among the commercially insured in the U.S., 2008–2017

Desai, Raj; Park, Haesuk; Dietrich, Eric; Smith, Steven M.

doi:10.1016/j.ijchy.2020.100033

Cited by 10 publications

(10 citation statements)

References 16 publications

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“…The choice of uAOBP for both the confirmation of the diagnosis and the evaluation of the patients may thus be seen as a limitation of the study but it is associated with less burden for the patients than ABPM, which requires repeat recording until validated. Moreover, like ABPM, uAOBP minimizes white coat effect 31 secondary to sympathetic activation 32 and may be closer to worldwide medical practice 33 …”

Section: Discussionmentioning

confidence: 99%

Identifying and treating resistant hypertension in PRECISION: A randomized long‐term clinical trial with aprocitentan

Danaietash

Verweij

Wang

et al. 2022

J of Clinical Hypertension

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The design and baseline data of the PRECISION study, which evaluates the effect of the dual endothelin receptor antagonist aprocitentan on blood pressure (BP) in patients with resistant hypertension (RHT) are presented. The study is a blinded, randomized, parallel-group Phase 3 study and its three-part design assesses the short-term and sustained long-term effects of aprocitentan on BP. Results are expected in 2022.Patients with uncontrolled BP (measured as unattended automated office BP) despite the use of three or more antihypertensive medications for at least 1 year were screened. They were switched to a single-tablet triple fixed combination antihypertensive therapy for at least 4 weeks before entering a single-blind placebo run-in period.The 4-week placebo run-in period further excluded placebo responders. The randomization period consisted of three sequential parts: (1) a 4-week double-blind part with aprocitentan 12.5 mg, 25 mg, or placebo (1:1:1 ratio); (2) a 32-week single-blind part with aprocitentan 25 mg; and (3) a 12-week randomized withdrawal part with aprocitentan 25 mg or placebo (1:1 ratio). The purpose was to demonstrate the BP lowering effect of aprocitentan in RHT (Part 1) and the persistence of this effect (Parts 2 and 3).Out of 1965 screened patients, 730 were randomized resulting in an overall inclusion failure rate of 62.8%. The most common reason for exclusion (44.4% of all screened patients) was failure to meet the BP inclusion criteria. These results underline the high proportion of pseudoresistant hypertension among patients referred for RHT.

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Section: Discussionmentioning

confidence: 99%

Identifying and treating resistant hypertension in PRECISION: A randomized long‐term clinical trial with aprocitentan

Danaietash

Verweij

Wang

et al. 2022

J of Clinical Hypertension

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“…For example, we previously showed that ABPM claim submissions decreased from 2008 to 2017 and fewer than 0.5% of commercially insured patients with hypertension have had ABPM claims billed to their commercial insurance. 4,7 We hypothesized that one possible explanation for these findings could be low patient acceptance, either because ABPM is cumbersome or because of OPP burden. Our present findings suggest the latter may not be the primary barrier for most individuals with coverage, particularly when excluding deductibles from OPP calculation.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Ambulatory BP monitoring (ABPM) provides more reliable and stable BP measurement than office BP. However, ABPM is underutilized in the United States, 4 where the costs of the device and its maintenance, including training of administrative and medical staff to fit the device and interpret BP readings, remain relatively high. 5 Medicare pays a median rate of $52, varying modestly by geographic region, per ABPM session.…”

mentioning

confidence: 99%

Out-of-Pocket Payment for Ambulatory Blood Pressure Monitoring Among Commercially Insured in the United States

Desai

Dietrich

Park

et al. 2020

American Journal of Hypertension

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Background Clinical guidelines increasingly recommended ambulatory blood pressure monitoring (ABPM) for hypertension diagnosis and management. Yet, ABPM is used infrequently in the United States, possibly because of low insurance coverage and high patient costs. We sought to analyze out-of-pocket payments (OPPs) for ABPM among privately insured patients. Methods We conducted a retrospective analysis using IBM® MarketScan® commercial claims of beneficiaries aged ≥18 years receiving ABPM from January 2012 to December 2018. The date of first ABPM claim (Healthcare Common Procedure Coding System codes 93784, 93786, 93788, or 93790) was considered the index date. Patients with 12 months of continuous enrollment preindex and 30-day postindex were included. Per beneficiary OPP was calculated by aggregating all ABPM-related OPPs within the 30-day postindex window (ABPM episode). Results Of 22,317 beneficiaries receiving ABPM, 62% had $0 OPP and 38% had OPP >$0. Among the latter, median OPP per beneficiary for an ABPM episode was $23 (interquartile range [IQR], $14, $32), driven primarily by full ABPM claims (median, $22; IQR, $14, $24). Among individual components, scan analysis and report claims (median, $25; IQR, $13, $49) had the greatest OPP. The median OPP per ABPM episode did not change substantively from 2012 through 2018. Conclusions Among commercially insured in the United States, nearly 4-in-10 have an OPP for ABPM. Though most OPPs are relatively modest, some patients incur substantial OPP. Our findings highlight the need for policymakers to ensure adequate ABPM coverage in the commercial insurance marketplace.

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“…Accordingly, office BP, which provides only a snapshot of the BP level at one time and in an environment that may promote an alerting response, cannot possibly be expected to provide information as valuable as ABPM and reflective of the true underlying BP. Prior studies using office BP have demonstrated that it is only through serial measurements over a span of 4-5 visits that a stable BP is achieved [15] . Waiting this long to decide on the direction of therapy is clearly not practical enough to be implemented in routine clinical care delivery workflows, which results in the unfortunately common practice of usually using a single office reading from a single visit to make a diagnosis of hypertension or titrate drug therapy.…”

Section: Indications For Abpm Usementioning

confidence: 99%

How a cloud based platform can make ambulatory blood pressure monitoring more efficient, accessible, and evidence based

Padwal¹,

Wood²,

Ringrose³

2022

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Ambulatory blood pressure measurement (ABPM) is the gold-standard method for blood pressure assessment. However, it is markedly underutilized, in part because legacy software provided with ABPM devices is archaic and inefficient. Herein, we illustrate an example of a recently developed cloud-based ABPM platform. Such a platform offers several distinct advantages: (1) the ability to guide users through the testing process; (2) synchronizing inputs of the technician, patient, physician, and administrative assistant so that testing can be successful and efficient; (3) providing guideline-concordant study interpretations that can be e-signed, reducing physician interpretation times; (4) enabling central expert oversight and peripheral deployment of testing, thereby increasing accessibility of quality testing; and (5) facilitating integration into electronic medical records, improving dissemination of results. It is envisioned that increased use of cloud-based ABPM platforms will lead to the expansion of quality ABPM testing, thus improving the care of patients with known or suspected hypertension.

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Trends in ambulatory blood pressure monitoring use for confirmation or monitoring of hypertension and resistant hypertension among the commercially insured in the U.S., 2008–2017

Cited by 10 publications

References 16 publications

Identifying and treating resistant hypertension in PRECISION: A randomized long‐term clinical trial with aprocitentan

Identifying and treating resistant hypertension in PRECISION: A randomized long‐term clinical trial with aprocitentan

Out-of-Pocket Payment for Ambulatory Blood Pressure Monitoring Among Commercially Insured in the United States

How a cloud based platform can make ambulatory blood pressure monitoring more efficient, accessible, and evidence based

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