Trends in ambulatory blood pressure monitoring use for confirmation or monitoring of hypertension and resistant hypertension among the commercially insured in the U.S., 2008-2017

Background: Ambulatory blood pressure monitoring (ABPM) has been increasingly recommended for diagnosis confirmation and monitoring in patients with new-onset hypertension and apparent treatment-resistant hypertension (aTRH). We assessed insurance claims submitted for ABPM among a nationally representative sample of commercially insured U.S. patients. Methods: We conducted a retrospective cross-sectional analysis using the IBM MarketScan (R) commercial claims database from January 2008-December 2017, including 2 populations: those with incident treated hypertension (ITH; first antihypertensive filled) or aTRH (first overlapping use of 4 antihypertensive agents). We identified ABPM claims filed within 6 months before to 6 months after the qualifying antihypertensive fill and determined prevalence of ABPM use overall and by year in each population. Results: In total, 2,820,303 patients met ITH criteria and 298,049 met aTRH criteria. Of those with ITH, 7650 (2.7 per 1000 persons) had >= 1 ABPM claim submitted, and annual ABPM prevalence ranged from 2.0 to 3.7 per 1000 persons, increasing over time (P-trend<0.0001). Among those with aTRH, 630 (2.1 per 1000 persons) had >= 1 ABPM claim submitted, and annual ABPM prevalence ranged from 1.6 to 2.7 per 1000 persons, decreasing over time (P-trend = 0.054). Timing of ABPM claims suggested they were used primarily for diagnosis confirmation in ITH, and more evenly distributed between diagnosis confirmation and monitoring in aTRH. Conclusions: Despite guideline recommendations for more widescale use, ABPM appears to be used rarely in the U.S., with fewer than 0.5% of commercially insured patients with newly treated hypertension or aTRH having ABPM claims submitted to their insurance.