Ambulatory BP Monitoring Appears to Be Cost-Effective for Diagnosing Hypertension

In a hypothetical cohort, ambulatory blood pressure monitoring was better than office- or home-based monitoring.


In some studies, ambulatory blood pressure (ABP) correlates more strongly with adverse cardiovascular outcomes than does either office-based BP (OBP) or home-based BP (HBP). Hypertension usually is diagnosed with OBP monitoring, with ABP monitoring used mainly to resolve diagnostic uncertainty or to confirm antihypertensive treatment effectiveness. ABP monitoring could serve as a diagnostic standard for hypertension that requires treatment, but would it be cost-effective?

British researchers modeled a hypothetical population (age, ?40) with screening BP measurements >140/90 mm Hg, risk profile equivalent to the general population, and diagnoses of hypertension by OBP, HBP, or ABP monitoring. The researchers used evidence-based assumptions for prevalence of hypertension, sensitivity and specificity of OBP and HBP monitoring relative to ABP monitoring, and probabilities of adverse cardiovascular events. The simulation ran for the equivalent of 60 years; assumptions were that blood pressure checks occurred every 5 years for healthy patients and that generic medications were prescribed as needed.

ABP monitoring was the most cost-effective diagnostic strategy for men and women of any age and maintained its advantage when underlying assumptions were varied. The higher cost of diagnosis using ABP monitoring was more than offset by eliminating the costs of unnecessary treatment. In older cohorts, ABP monitoring also produced better health outcomes.


Citation(s):

Lovibond K et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: A modelling study. Lancet 2011 Aug 24; [e-pub ahead of print].