Ambulatory blood pressure monitoring (ABPM) is used widely in secondary care hypertension clinics, so what about its use in the primary care setting, where the majority of hypertension clinics take place? What are the potential benefits of ambulatory monitoring? Which patients should ABPM be used for? In this article we review the nuts and bolts of ABPM – when to use it, how to perform the test to obtain an accurate assessment of 24-hour BP and how to apply the results in clinical practice.
Measuring blood pressure (BP) is one of the commonest tests we carry out in primary care – generally taking several measurements with a digital BP monitor on at least two clinic visits before diagnosing hypertension. Ambulatory blood pressure monitoring (ABPM) has traditionally been used in secondary care hypertension clinics, and in some larger general practices. But new guidelines from the National Institute for Health and Clinical Excellence are making ambulatory monitoring part of routine practice for the diagnosis of hypertension in primary care. What are the new guidelines recommending and why the change to ABPM?
NICE now recommends that 24-hour ambulatory blood pressure monitoring (ABPM) rather than repeat clinic measurements should be the gold-standard test for diagnosing high blood pressure. This article considers the practicalities of using ABPM in the clinic, including advice to pass on to patients to ensure accurate readings.
A major study funded by the National Institute for Health Research concludes that more frequent lipid monitoring strategies are cost-effective when compared with other longer interval strategies to guide treatment for prevention of cardiovascular disease.
This article will examine the issues surrounding blood glucose monitoring for people treated with insulin.It will look at the practical skills required for patients to test accurately,the roles of the individual patient and the healthcare professional in successful monitoring,and the equipment required.The aim of the article is to ensure that monitoring justifies the expense and time involved by achieving good glycaemic control.
The association between body mass index (BMI) and mortality from both cardiovascular disease (CVD) and coronary heart disease (CHD) is well accepted. Individuals with high BMIs are also at increased risk of developing other conditions such as sleep apnoea, osteoarthritis, female infertility, varicose veins, gastro-oesophageal reflux and stress incontinence. BMI has been the gold standard for predicting health by measuring body weight in relation to height. However, although BMI may be helpful in estimating overall obesity, it is becoming increasingly apparent that waist-hip ratio, which estimates central obesity, is a more accurate predictor of the risk of health problems generally and CVD in particular.
Most people with coronary heart disease (CHD) can be managed with lifestyle change and optimal medical therapy, but some patients need to be referred for revascularisation procedures such as angioplasty with stenting (also called percutaneous coronary intervention; PCI). Practice nurses have an important role to play in follow-up of these patients to minimise adverse events, promote lifestyle change and ensure continuing concordance with medication.
The British Heart Foundation has launched the Miles Frost Fund to establish a UK-wide cascade testing service for families at risk of hypertrophic cardiomyopathy (HCM). The fund has been established in memory of Sir David Frost’s son Miles who died suddenly from an undiagnosed heart condition in 2015.
Glucose monitoring has revolutionised the management of diabetes by providing the means for patients to check their blood glucose level in real time. This review provides an update on continuous glucose monitoring, looks at the devices available and analyses what the strategy adds to diabetes management.