Ambulatory monitoring recommended for most before the start of antihypertensives

January 01, 0001

Ambulatory monitoring recommended for most before the start of antihypertensives

The diagnosis of hypertension has traditionally been based on blood-pressure measurements in the clinic, but home and ambulatory measurements better correlate with cardiovascular outcome, and ambulatory monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension. The researchers from the UK aimed to compare the cost-effectiveness of different diagnostic strategies for hypertension.

Ambulatory monitoring was the most cost-effective strategy for the diagnosis of hypertension for men and women of all ages. It was cost-saving for all groups and resulted in more quality-adjusted life years for men and women older than 50 years. This finding was robust when assessed with a wide range of deterministic sensitivity analyses around the base case, but was sensitive if home monitoring was judged to have equal test performance to ambulatory monitoring or if treatment was judged effective irrespective of whether an individual was hypertensive.

The researchers concluded: "Ambulatory monitoring as a diagnostic strategy for hypertension after an initial raised reading in the clinic would reduce misdiagnosis and save costs. Additional costs from ambulatory monitoring are counterbalanced by cost savings from better targeted treatment. Ambulatory monitoring is recommended for most patients before the start of antihypertensive drugs."

Does this have any impact on previous epidemiological studies of hypertension and treatment and outcomes?

For the full abstract, click here.

The Lancet published online 24 August 2011 © 2011 Elsevier Limited
Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Kate Lovibond, Sue Jowett, Pelham Barton et al. Correspondence to Sue Jowett:

Category: K. Circulatory. Keywords: high blood pressure, options, cost-effective, diagnosis, primary care, modelling study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 30 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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