Taking repeated blood pressure readings over a 24-hour period rather than a one-time measurement in the clinic is the most cost-effective way of identifying patients who need antihypertensive drugs, according to a study published.
The findings in favour of ambulatory blood pressure monitoring were immediately adopted by Britain's health costs watchdog, the National Institute for Health and Clinical Excellence (NICE), in new guidelines on how to diagnose and when to treat high blood pressure.
Bryan Williams, a professor of medicine at the Leicester University and chair of the NICE guideline development group, said the change would affect the treatment of millions of people in Britain and was "a step-change that is likely to be replicated across the world".
"Ambulatory monitoring allows better targeting of blood pressure treatment to those who will receive most benefit," said Richard McManus of Britain's Birmingham University, who led the study that prompted the NICE guideline change.
"It is cost saving in the long term as well as more effective, and so will be good for patients and doctors alike."
In a study report in The Lancet, McManus' team analysed the cost-effectiveness of the three approaches - further blood pressure measurement in the clinic, at home, and with an ambulatory monitor.
They used a Markov model-based probabilistic cost-effectiveness analysis and a hypothetical primary-care population aged 40 years or older with a screening blood-pressure above 140/90 mmHg and risk-factor prevalence equivalent to the general population.
Ambulatory monitoring was the most cost-effective strategy for diagnosing hypertension in both genders and at 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.
McManus said the new NICE guidelines marked a significant change in hypertension care. "The use of ambulatory monitoring will ensure quicker and more accurate diagnosis," he said, adding that this was "an exciting advance which I am sure will be taken up internationally."
(Reuters Health, Kate Kelland , August 2011)
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