Abstract P2067: Trends in Ambulatory and Home Blood Pressure Monitoring Use for Confirmation of Hypertension or Resistant Hypertension Among the Commercially-Insured in the U.S., 2008-2017

Abstract

Objectives: Out-of-office BP measurement, including ambulatory and home BP monitoring (ABPM, HBPM, respectively) are considered the gold standard for hypertension and treatment-resistant hypertension (TRH) confirmation, but their real-world use is not well-studied. We examined recent trends in submitted claims for ABPM and HBPM among commercially-insured U.S. adults with suspected hypertension or TRH. Methods: Using Truven commercial claims data (2008–2017), we identified adults (age ≥18 years) with hypertension, and ≥1 antihypertensive medication fill. We evaluated CPT codes for claims submitted for ABPM and HBPM from 6 months before to 1 month after initial antihypertensive drug use (incident treated hypertension [ITH] cohort) or the first occurrence of overlapping use of ≥4 antihypertensive drugs (incident TRH cohort). We excluded persons without continuous enrollment during the 7-month observation period. Results: Overall, 3,378,645 patients with ITH and 335,200 with incident TRH met inclusion criteria. Of those with ITH, 13,063 (3.9 per 1,000 persons) had ≥1 ABPM or HBPM claim between 6 months prior to and 1 month after initiating treatment. The annual proportion of patients with ≥1 claim ranged from 1.6 to 3.0 per 1,000 for ABPM and 1.3 to 2.1 per 1,000 for HBPM. Among those with incident TRH, 1126 (3.4 per 1,000) had ≥1 ABPM or HBPM claim between 6 months prior to and 1 month after initiating a fourth agent. The annual proportion with ≥1 claim ranged from 1.2 to 2.0 per 1,000 persons for ABPM and 1.1 to 2.9 per 1,000 for HBPM. From 2008 to 2017, use of ABPM modestly increased in the ITH cohort and decreased in the TRH cohort; no time trends were observed with HBPM. Sensitivity analyses suggested that ABPM was used most often for diagnosis confirmation (especially in the ITH cohort), followed by treatment monitoring, whereas HBPM was distributed more evenly. Conclusion: Our findings suggest ABPM is used rarely for guiding treatment initiation decisions among those with incident hypertension or apparent TRH. Claim submissions for HBPM were similarly low, but a significant proportion of HBPM may occur without attempting reimbursement. Future research is needed to understand the factors responsible for low utilization, billing and coverage of these services.