Training in ABPM, the “Renal Biopsy” of Hypertension

24 hour Ambulatory Blood Pressure Monitoring (ABPM) is the gold-standard for diagnosing sustained, white coat, and masked hypertension. It’s a better predictor of cardiovascular events than office readings and carries a Grade A recommendation by the United States Preventative Services Task Force (USPSTF).

The evidence is unequivocal and yet not all nephrologists perform ABPMs.  Fellows have even less exposure to implementation, interpretation, and reimbursement.

Last year, Raymond Townsend of U Penn and Daichi Shimbo of Columbia-Presbyterian created a course to address the above deficiencies. In addition to reviewing the evidence and billing aspects, the course focuses on practical considerations such as learning about the software and monitoring protocols, and correctly educating the patient on the dos/don’ts while wearing the monitor. The hands-on session allows attendees to familiarize themselves with the various models and wear an ABPM for the afternoon.

After attending last year, I not only gained a deeper understanding of ABPM but now have a resource for future questions. This year’s course (1 day) will be held on Monday, September 11th, in San Antonio, TX. 

www.abpmcourse.com

I have no financial or formal relationship with the organizers.

Hillel Sternlicht, MD

Author, Concepts in Hypertension Newsletter

A Fresh Approach to Understanding Clinical Hypertension

With advances in the field of nephrology broadening our knowledge of transplant medicine, glomerular disease, and the interventional aspects of access, I believe fellowship training in the traditional areas of the specialty such as hypertension have diminished.

And yet, apart antibiotics, anti-hypertensives are the single most important therapy contributing to rising life expectancies. Because while ESRD trials focus on endpoints such as PTH levels and the CKD literature uses outcomes such as a doubling of serum creatinine, hypertension studies utilize clinical endpoints such as all cause mortality.  Moreover, it’s a fascinating disease, our understanding of which is unrivaled by any other condition. What is the circadian rhythm of blood pressure? How does pulse pressure affect the risk of CAD? What is the relationship between basal heart rate and mortality? To understand hypertension is to appreciate human physiology, to apply evidence-based medicine, and to practice cost effective care. Moreover, despite the proliferation of national treatment guidelines, management is more nuanced than targeting similar blood pressure levels for all patients and prescribing the same handful of agents. The “art” of management hinges on understanding the difference between metoprolol and betaxolol, hydrochlorthiazide and indapamide, and losartan and azilsartan. As such, if there is one disease to know, and know well it’s hypertension.

To improve my own knowledge of the above, I’m currently undertaking an additional fellowship in hypertension under George Bakris at the hypertension center here at the University of Chicago. In order to share what I have learned, I’ve created a bi-weekly e-newsletter, “Concepts in Hypertension,” as a non-commercial medium to convey key aspects of the disease. Each issue is concise, summarizing one seminal paper and underscoring one key concept. The newsletter then ends with a “clinical perspective” that indicates how the selected paper informs the management of patients at our hypertension center.

Below are several recent issues. If you’d like to subscribe to this free, non-commercial publication, you can do so by visiting www.bp-specialists.com/newsletter

Rethinking HCTZ as your diuretic of choice

The Circadian Rhythm of BP: Why AM BP control is critical

Low Dose Combination Therapy: Why less is more

Pulse Pressure-What it is and why it matters

Hillel Sternlicht

The University of Chicago