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24-Hour Blood Pressure Determination
Good for the patient - good to increase your reimbursement.
A large study involving thousands of patients in Scandinavia pointed out that those patients with a blood pressure of 120/80 suffered almost no catastrophic illness. Those who had a blood pressure in excess of 120/80 suffered heart attack, stroke, peripheral vascular arterial disease, kidney failure, and diabetes in great numbers. This is one of the studies that prompted the new standards for determining blood pressure values. It has been recommended that the patient be sitting for 20 minutes before a blood pressure determination is made.
When I started in the practice 30 years ago, a value of 140/90 was considered the maximum pressure. Then there was a change. The American Heart Association said that 140/90 was too high and they recommended 135/85. Then, with the increases in heart attack and kidney failure continued to rise, along with hyperlipidemia, the high limits of normal were reduced to 120/80. When it was found that people less than 18-years-old were becoming hyperlipidemics and had increased blood pressure, the high limit of normal was reduced to 120/80. This is considered at this time to be the acceptable limit for blood pressure at the desired range.
I think we will all agree that blood pressure is a killer. Even though the medical community is starting to accept the belief that nannobacterium are the culprits, and they are causation for plaque formation in our arteries – the idea has been slow to catch on. We know that chronic inflammation from the gums, the prostate, the sinuses, the vagina, and the bladder are all implicated. Thus, the thinking physician will screen all his patients over 40 years of age with a C-reactive protein and homo-cystine determination.
Years ago, at one of our medical meetings, I had the pleasure of having breakfast with the father of coronary artery bypass surgery, Jr. Charles Debakey. To my amazement, this physician (who always wore jodhpurs) ordered three fried eggs, six strips of bacon, four pieces of buttered toast and a huge glass of whole milk, along with cream in a cup of coffee. I asked him this question: “Dr. Debakey, everything you’ve ordered today is high in cholesterol. Aren’t you afraid of high cholesterol and coronary artery disease?”
He looked at me very benevolently. In addition, with a smile said, “Sonny, cholesterol is NOT all of the answer. Always keep your blood pressure under control, and you’ll be okay.” I’ll never forget what he said to me. Blood pressure has great significance as to the harm it can cause.
The patient who is consistently at 140/90 deserves treatment to bring them below this level. But what about the patient who you see monthly for many medical problems, AND for manipulative treatment, who presents one month with 130/80 and the next time 150/95 and the next month 135/85. The next month 160/95. The question is: Do you treat or not? The blood pressure findings are too inconsistent to make that decision.
There is a simple way to solve this dilemma – and that solution is a 24-hour blood pressure monitoring test. The patient comes in a 9am and you hook he/she up with the blood pressure sensor that works 24 hours per day. The patient returns the next day at 9am, you unhook the equipment, put the information into the computer, and review the records. The printout will show you blood pressure determination done every 12 minutes. It will tell you the highest and lowest readings for the last 24-hour period. It will also show you the average blood pressure while awake, the average blood pressure while asleep, and will show you when the highest blood pressure occurs.
For example, the person who works from 7am to 4pm lifting heavy boxes of metal parts, all day long, the pressures are bound to be higher than resting pressures at times other than work time. You will have to work with the averages shown on the print out to determine RX, if at all.
As another example, for the person who has the highest blood pressure readings from 10PM to 6AM, you might consider what is going on in the subconscious mind. Maybe a trial of an anti-anxiety, anti-depressant medicine might do the job to correct blood pressure, rather than a hypotensive agent. When you read the readings, you can make the decision as to whether or not you wish to treat blood pressures over 120/80. You will have the evidence right in your hands.
I am not recommending one particular machine. Go on to the Internet, get the name of the company, ask the price for a new machine, then ask the price for a “demonstrator” Model – then ask the price for a reconditioned machine with a one year warranty. Do not accept the first price thrown at you. Haggle a little bit (they expect it, and they want to make a sale).
The reimbursement is good: Medicare pays $125.00; Medicaid pays $125.00 and 3rd party payors like Blue Cross/Blue Shield pay $200.00. To find out how much to file, look in the freedom of information materials. It will give you a proper fee to charge.
