24/7 ABPM Guidelines Revisited

NICE clinical guideline 127 states that ABPM monitoring is the most accurate method for confirming a diagnosis of hypertension, and its use should reduce unnecessary treatment in people who do not have true hypertension. Originally published in 2013 it was updated in September 2015.

In a recent review with our technical support team I asked them what were the practical questions they were most frequently asked about the guideline and ABPM in general.

I thought I would share the results on our Blog as they may be of interest to other ABPM customers. In no particular order this is what they told me.

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Ambulatory blood pressure monitors. Are you getting good value?

The cost of ABPM monitors has fallen considerably in recent years but purchasers should check that there are no hidden extras and that the supplier is able to offer free technical support, installation training and advice to nurses who generally fit the monitor.

As some manufacturers offer expensive additional warranties or support contracts the true “whole life” running costs including maintenance should be factored in to the purchasing decision.

All modern 24-hour monitors like the Meditech ABPM-04, Meditech ABPM-05 and TM-2430 now use PC-based software and in most instances it is possible to attach the patient’s report to popular clinical management systems, such as EMIS and SystmOne.

Again it is worth checking that this is included and that there are no expensive annual licence fees or dongles required, as well as checking that multiple copies can be installed without additional cost.

An ABPM report should include, as a minimum, daytime and night-time averages, a list of BP data and trend graph on one or 2 sheets of A4 paper.

Normal mean levels for ABPM in adults are slightly lower than surgery readings at 135/85 for daytime average and 120/70 when asleep.

The results can usually be interpreted by suitably qualified clinicians. The latest version of CardioVisions that works with the Meditech ABPM-04 and Meditech ABPM-05 provides additional automatic analysis to the NICE 2011 guidelines and this can save time and ensure consistent reporting.

Ideally, the monitor should be able to use rechargeable batteries to minimise costs. A wide range of cuff sizes should be available but the adult and large adult will probably be used the most popular. Cuff barriers like those from TIDI can help keep cuffs hygienic and prevent soiling.

Most but not all companies will offer additional training if required.

As with any piece of medical equipment used in patient diagnosis, routine calibration and servicing is important. This should only be undertaken by authorised service technicians that have access to original manufacturer parts and test equipment.

With any ABPM this should be available in the UK from the supplier to avoid unnecessary downtime.

As with all things it’s unwise to pay too much but sometimes risky to pay too little.