Ambulatory blood pressure monitoring may be most cost-effective for hypertension diagnosis

Ambulatory measurement is the most cost-effective method of diagnosing high blood pressure, a new analysis concluded.

The Markov model-based analysis used a hypothetical primary care population age 40 or over with a screening blood pressure measurement over 140/90 mm Hg and an average risk factor prevalence. Researchers compared three strategies for definitively diagnosing hypertension: additional clinic measurements, home measurement, and ambulatory monitoring. The results were published online Aug. 24 by The Lancet.

Ambulatory monitoring was found to be the most cost-effective strategy, because it was cost-saving in all age and sex subgroups and it resulted in more quality-adjusted life-years for people over 50. The authors used a wide range of sensitivity analyses and found the results to be robust, except if home monitoring was considered to be as effective as ambulatory monitoring. Ambulatory monitoring costs more than the other methods, but the costs are counterbalanced by savings from better targeted treatment, the authors said.

The cost-effectiveness of ambulatory monitoring could be even greater than the study found because the model was based on generic drug costs and assumed no negative quality of life effects from a diagnosis of hypertension (in patients who both did and didn't actually have the condition). An accompanying comment noted that the model also assumed no benefit to hypertension treatment for people whose blood pressure was below 140/90 mm Hg.

The model also assumed a 5-year cycle of rescreening, and ambulatory monitoring would not be as cost-effective in younger patients if it were conducted annually, the study authors cautioned. Overall, however, they recommended that ambulatory monitoring be seriously considered for most people before the start of hypertension treatment.