Diagnosing hypertension: show me the money
It is almost impossible to keep up to date with all the developments in medicine, but there are certain core conditions that we should all take an interest in. One such condition is hypertension, particularly if you are a GP. It is well within the province of primary care to diagnose, treat and manage hypertension as well as to recognise the exceptions where referral to secondary care may be necessary.
So it caught my eye when the univadis GP News service proclaimed a new era in hypertension management (click here to read more). NICE have published updated guidelines for the diagnosis and management of hypertension and according to the article they confirm "that ambulatory 24-hour blood pressure monitoring (ABPM) is to become the new standard of care".
Among a number of documents on the NICE website the following quick reference, which still runs to 16 pages, is most useful (click here). Furthermore, the first sentence of the introduction brings home the importance of this initiative, stating: "Hypertension is one of the most important preventable causes of premature morbidity and mortality in the UK". There is also a lot of other information available from NICE on the modern management of hypertension and I would think this summary document is an essential read for all clinical primary care staff (click here).
In addition, the univadis article highlights research published in The Lancet showing that ABPM is a cost-effective way of diagnosing hypertension. The devices do not come cheap - the article quotes that these machines will cost in the region of between £1000 and £2000. But according to the report, "ambulatory monitoring was most cost-effective, offering cost-savings of £50-£323 per patient and resulting in small but significant improvements in quality of life".
A question that's bothering me though, is who is going to pay for this? I would guess that in order for the initiative to get off the ground, there will have to be some funding from somewhere. But after wading through some of the NICE documents as well as checking out the website of the British Hypertension Society (click here), so far I have not been successful. I am still not clear on how the funding will work to supply the ABPM units and if anyone knows the answer to this, please let me know.
Dr Harry Brown, editor-in-chief univadis
By Dr Harry Brown