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23-08-2011 | General practice | Article

Hypertension diagnosis revolution

Abstract

Lancet 2011; Advance online publication

NICE confirmed today that ambulatory 24-hour blood pressure monitoring (ABPM) is to become the new standard of care, with latest research showing it is cost-effective for diagnosing hypertension.

The study, published online in The Lancet, found that ABPM was the most cost-effective diagnostic strategy in men and women of all ages. In light of the new evidence, NICE is recommending ABPM as best practice in updated guidelines devised jointly with the British Society of Hypertension.

"Even though these new devices cost £1000-£2000, our analyses suggest that by improving the speed and accuracy of diagnosis, we will actually save money by only targeting treatment at those who need and will benefit from treatment," said Professor Bryan Williams (University of Leicester), who led the guidelines development team.

The Lancet study, by Professor Richard McManus (University of Birmingham) and colleagues, modelled costs associated with three strategies for hypertension diagnosis in primary care. The three options were clinic, home or ambulatory monitoring, applied to a hypothetical primary-care population aged 40 years or older with a screening BP above 140/90 mmHg.

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.

In a linked editorial, Dr Thomas Gaziano (Brigham and Women's Hospital, Boston, USA) said the cost-savings were not surprising. "Improved diagnosis by both home and ambulatory monitoring results in reduction of morbid or fatal, as well as expensive, events attributable to cardiovascular disease, and minimises treatment of people who otherwise would be incorrectly labelled hypertensive," he wrote.

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Joanna Lyford