Diagnostic value and cost-benefit analysis of 24 hours ambulatory blood pressure monitoring in primary care in Portugal

Abstract

BackgroundHypertensive patients (HTs) are usually attended in primary care (PC). We aimed to assess the diagnostic accuracy and cost-benefit ratio of 24-hour ambulatory blood pressure monitoring (ABPM) in all newly diagnosed hypertensive patients (HTs) attended in PC.MethodsIn a cross-sectional study ABPM was recorded in all 336 never treated HTs (Office BP ≥140 and/or ≥ 90 mm Hg) that were admitted during 16 months. Since benefits from drug treatment in white-coat hypertension (WCH) remain unproven, a cost benefit estimation of a general use of ABPM (vs absence of ABPM) in HTs was calculated comparing the cost of usual medical assistance of HTs only diagnosed in office with that based both on refraining from drug treatment all subjects identified as WCH and on the reduction by half of the frequency of biochemical exams and doctor visits.ResultsWomen were 56%, age 51 ± 14 years and BMI 27 ± 4 Kg/m2. Out of these, 206 were considered as true HTs, daytime ABPM ≥ 135 and/or ≥85 mm Hg and 130 (38,7%) were identified as having white coat hypertension (WCH), daytime ABPM <135/85 mm Hg. Versus HTs, WCH group showed higher percentage of women (68% vs 51%) and lower values of an index composed by the association of cardiovascular risk factors. We estimated that with ABPM total medical expenses can be reduced by 23% (157.500 euros) with a strategy based on ABPM for 1000 patients followed for 2 years.ConclusionsIn PC, the widespread use of ABPM in newly diagnosed HTs increases diagnostic accuracy of hypertension, improves cardiovascular risk stratification, reduces health expenses showing a highly favourable benefit-cost ratio vs a strategy without ABPM.

The Diagnostic Value of 24-Hour Ambulatory Blood Pressure Monitoring in Family Medicine Clinics

“…Numerous other factors can influence the differences in BP measured at the clinic and with ABPM, such as the number, times, and schedule of measurements 17 . BP values measured in the clinic and using ABPM were higher in patients with previously diagnosed arterial hypertension, and similar results were described by other authors as well 18 . In line with previously published studies, we found higher BP values measured both in the clinic and using ABPM in older patients 19 .…”

Scaling up the use of home blood pressure monitoring in the management of hypertension in low‐income countries: A step towards curbing the burden of hypertension

“…In a recent community‐based case‐control study in Kenya including 1248 participants, CBPM significantly overestimated the prevalence of hypertension while missing about half of the participants with true hypertension diagnosed by ABPM . Even though WCH is associated with mild cardiovascular risk, studies have failed to demonstrate a benefit of antihypertensive treatment in preventing cardiovascular events in patients with WCH . Therefore, treatment of this condition is unjustified, except in the context of target organ damage, although regular follow‐up is warranted .…”

“…Even though WCH is associated with mild cardiovascular risk, studies have failed to demonstrate a benefit of antihypertensive treatment in preventing cardiovascular events in patients with WCH . Therefore, treatment of this condition is unjustified, except in the context of target organ damage, although regular follow‐up is warranted . Thus, out‐of‐office BP measurement techniques are critical for the identification of patients with WCH who do not need treatment.…”

“…In spite of the aforementioned advantages, the use of out‐of‐office BP monitoring in LICs is still far below standard, partly because of the cost of monitoring and a deficiency in knowledge on the pros and cons of these methods. When these methods are employed in the diagnosis and surveillance of hypertension, they are more cost‐effective in the long run when compared with CBPM by reducing the number of unnecessary return visits and antihypertensive drugs in chronic users . In a controlled randomized trial by Soghikian and colleagues, HBPM reduced the cost of hypertension care by 29% compared with CBPM.…”

24-Hour Ambulatory Blood Pressure Monitoring Predicts Outcomes of Hypertensive Patients in Primary Care: A Cohort Study

“…1 Epidemiological studies have provided unequivocal evidence for the association between arterial hypertension and mortality from ischemic heart disease, cerebrovascular accident (CVA), and vascular diseases. 2 Additionally, there is a strong association between blood pressure (BP) reduction and prevention of coronary artery disease (CAD) and CVA. 3 The number of individuals with uncontrolled hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) increased from 605 to 978 million, among other causes, influenced by population aging.…”