Behind The News - 29 May 2012

MO asks experts for their opinions on the clinical or political issues making headlines.

THE High Blood Pressure Research Council of Australia has renewed its advocacy for more widespread use of ambulatory blood pressure monitoring in primary care.

This follows the release late last year of a consensus position statement developed by the council and the Heart Foundation recommending wider use of ambulatory blood pressure monitoring.

While it is considered accurate and speeds up diagnosis, the lack of Medicare subsidy and other practical issues are impeding uptake by GPs.

Professor Geoff Head
Chair, ABP consensus committee
“It took us about two years to go through the literature and come up with a recommendation that is much more strongly suggesting that ABP should be used more widely in the diagnosis of hypertension.

“What the consensus statement did was... provide a framework of target blood pressures that you might aim to get to depending on the risk factors associated with that particular patient, so if it’s a high risk patient the targets should be lower. In the past that wasn’t available, you couldn’t use ABP monitoring for anything other than the diagnosis of grade 1 hypertension.

“There’s a little bit of a logistic exercise in looking at how to expand this recommendation but I think in the long run we’re at the cusp of the international movement away from solely clinic assessment.”

Dr Evan Ackermann
Chair, RACGP quality care committee
“We supported the position statement on ambulatory blood pressure monitoring... But there are other options out there.

“The problem with ambulatory blood pressure monitoring is there is a cost involved, and there’s certainly a cost involved for patients.

“There are training issues for general practice, which are not insurmountable but those issues are there. There would need to be some training for the interpretation of the results… And from a convenience point of view I guess it’s easier for general practices to organise for people to do home blood pressure monitoring themselves.

“Not many GPs out there have got the ABP monitoring equipment whereas most of them have got some home BP monitoring equipment.

“It’s certainly an option, but it’s not a gold standard.”