Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension

Costa, Diogo; Lima, Ricardo Peixoto

doi:10.1016/j.repce.2016.12.002

Cited by 4 publications

(2 citation statements)

References 35 publications

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“…However, there is a lack of evidence on patient preferences at the time of the diagnosis of hypertension. Physician decision-making in the choice of hypertension methods is also hampered by the lack of evidence on the direct costs because studies have focused on long-term cost-effectiveness ( 18 , 19 ). Therefore, the objective of this study was to evaluate the factors that most influence physicians and patients when choosing a BP measurement method: the accuracy of the method, the costs, and the patient experience.…”

Section: Introductionmentioning

confidence: 99%

Cost-accuracy and patient experience assessment of blood pressure monitoring methods to diagnose hypertension: A comparative effectiveness study

Paz

Kostov²,

Freixa³

et al. 2022

Front. Med.

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ObjectivesStudies of the diagnosis of hypertension have emphasized long-term cost-effectiveness analysis, but the patient experience and costs of blood pressure monitoring methods at the diagnosis stage remain unclear. We studied four diagnostic methods: a new 1 h-automated office blood pressure (BP) monitoring, office BP measurement, home BP monitoring, and awake-ambulatory BP monitoring.MethodsWe carried out a comparative effectiveness study of four methods of diagnosing hypertension in 500 participants with a clinical suspicion of hypertension from three primary healthcare (PHC) centers in Barcelona city (Spain). We evaluated the time required and the intrinsic and extrinsic costs of the four methods. The cost-accuracy ratio was calculated and differences between methods were assessed using ANOVA and Tukey’s honestly significant difference (HSD) post-hoc test. Patient experience data were transformed using Rasch analysis and re-scaled from 0 to 10.ResultsOffice BP measurement was the most expensive method (€156.82, 95% CI: 156.18–157.46) and 1 h-automated BP measurement the cheapest (€85.91, 95% CI: 85.59–86.23). 1 h-automated BP measurement had the best cost-accuracy ratio (€ 1.19) and office BP measurement the worst (€ 2.34). Home BP monitoring (8.01, 95% CI: 7.70–8.22), and 1 h-automated BP measurement (7.99, 95% CI: 7.80–8.18) had the greatest patient approval: 66.94% of participants would recommend 1 h-automated BP measurement as the first or second option.ConclusionThe relationship between the cost-accuracy ratio and the patient experience suggests physicians could use the new 1 h-automated BP measurement as the first option and awake-ambulatory BP monitoring in complicated cases and cease diagnosing hypertension using office BP measurement.

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Section: Introductionmentioning

confidence: 99%

Cost-accuracy and patient experience assessment of blood pressure monitoring methods to diagnose hypertension: A comparative effectiveness study

Paz

Kostov²,

Freixa³

et al. 2022

Front. Med.

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“…ABPM is a significantly better predictor of cardiovascular risk than CBP, and in the developed countries of North America and Europe, ABPM has proven cost‐effective, in part because the cost of the monitor is offset by savings in medication for people with WUCH . There are also likely to be outcome benefits with better‐targeted therapy, including treatment of individuals with MUCH .…”

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confidence: 99%

Ambulatory blood pressure monitoring and management of hypertension at a cardiac clinic in Kumasi metropolis, Ghana (Commentary)

Merwe¹

2020

J of Clinical Hypertension

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In this issue of the journal, Ntani and colleagues 1 from Ghana have published a retrospective observational study looking at the contribution of 24-hours ambulatory blood pressure monitoring (ABPM) to the management of hypertension in patients referred to an outpatient cardiology clinic.The medical records of 97 consecutive patients who had ABPM were reviewed for hypertension diagnosis and changes in management for 6 months post-ABPM. Individuals under 18 years of age were excluded, as were those with a diagnosed secondary cause of hypertension or a cardiovascular event in the prior 6 months.At the first visit, clinical and medication details were recorded, clinic blood pressure (CBP) was recorded by standard techniques, and a 24-hours ABPM undertaken. Based on these initial data, patients were categorized as controlled hypertension (CHT -CBP ≤ 140/90 and average daytime ambulatory BP ≤ 135/85), true uncontrolled hypertension (TUCH -CBP ≥ 140/90 and average daytime ambulatory BP ≥ 135/85), white coat uncontrolled hypertension (WUCH -CBP ≥ 140/90 and average daytime ambulatory BP ≤ 135/85), or masked uncontrolled hypertension (MUCH -CBP ≤ 140/90 and average daytime ambulatory BP ≥ 135/85).Mean age of the 97 patients studied was 55, of whom 52 were female. Average body mass index was 30 kg/m 2 . A total of 85 patients had previously diagnosed hypertension and were on prior antihypertensive therapy, 30% had dyslipidemia and 52.6% were recorded as having pre-existing hypertensive heart disease. Blood pressure medication use at baseline was a mean of 2.0 antihypertensive drugs. Mean CBP at the first visit was 139.7/80.6, and mean average daytime ambulatory BP was 131.3/85.3.A total of 47 (54%) had uncontrolled CBP at baseline vs 44 (50.6%) and uncontrolled average daytime ambulatory BP at baseline, but there was poor correlation between these two groups. Of the 87 patients already on antihypertensive medication, the diagnosis after 24-hours ABPM was CHT 26 (30%), MUCH 14 (16%), WUCH 17 (19.5%), and TUCH 30 (34.5%). Twenty-four-hours ABPM changed CBP-based diagnosis in 31 of these 87 patients (35.6%). (The authors do not provide the post-ABPM diagnosis for the 10 patients not previously on blood pressure medication). At the post-ABPM visit, 45/87 (51.7%) of the patients had their treatment modified, which included 7/87 (8%) discontinuing all medication, and 33 new antihypertensive medications were prescribed.Among the 64 patients in whom CBP records were available for 6 months prior to ABPM and 6 months post-ABPM, there was a significant reduction in mean systolic blood pressure (SBP), −6.2 mm Hg. In the 44 with uncontrolled average daytime ambulatory BP at baseline, the mean SBP reduction was −8.8 mm Hg, and among those with controlled average daytime ambulatory BP at baseline, mean SBP at 6 months post-ABPM was unchanged.As the authors comment, a single ABPM had substantial impact on hypertension diagnosis and management when added to standard CBP, and they provide evidence of significantly improved CBP at 6 mont...

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Ambulatory blood pressure monitoring in daily practice

Kinsara

2017

Indian Heart Journal

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Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension

Cited by 4 publications

References 35 publications

Cost-accuracy and patient experience assessment of blood pressure monitoring methods to diagnose hypertension: A comparative effectiveness study

Cost-accuracy and patient experience assessment of blood pressure monitoring methods to diagnose hypertension: A comparative effectiveness study

Ambulatory blood pressure monitoring and management of hypertension at a cardiac clinic in Kumasi metropolis, Ghana (Commentary)

Ambulatory blood pressure monitoring in daily practice

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