(MedPageToday) — Ambulatory blood pressure monitoring is the most cost-effective way to confirm a hypertension diagnosis before starting treatment, researchers found.
The cost-savings from avoiding misdiagnosis was greater with ambulatory monitoring than with further blood pressure measurements in the office or at home, Richard J. McManus, MSc, MBBS, of the University of Birmingham, England, and colleagues reported.
Ambulatory confirmation saved from $92 (£56) to $533 (£323) across groups in the modeling study released online in The Lancet.
Moreover, ambulatory monitoring slightly boosted quality-adjusted life years among patients older than 50.
“Ambulatory monitoring for most people before the start of antihypertensive treatment should be seriously considered,” McManus’ group argued in the paper.
In response, the British regulatory agency that helped fund the study is altering its guidelines to recommend ambulatory monitoring as a best practice.
The National Institute for Health and Clinical Excellence (NICE) announced the change at a press briefing held in London the same day as the Lancet paper was published.
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WHAT IS AMBULATORY MONITORING?
Ambulatory monitoring = a holter monitor. You wear a device for 24 hours which takes blood pressure readings at regular intervals. The results are then uploaded onto a computer and a graph is plotted. You also have to record what you are doing during the day, but this is ignored by most, if not all doctors.
It is a great help. One problem may be that BP goes up and down and variations of up to 30mmHg during the day may be possible, depending on activity. Due to the cut-off of 140/90 it may be possible that there may be readings above 140/90. If you are unlucky enough to have such readings, even an isolated one, during the day when you are wearing a monitor you could end up on medication. It is one of those things.
I had to drive home through heavy peak-hour traffic in a city and during that time my BP went up to 160/95. This was the highest reading during the 24 hour period and I was diagnosed with having high blood pressure requiring aggressive treatment. I ignored the doctor’s advice though as I believe it is normal / natural for BP to rise under these circumstances. But most doctors these days think otherwise. It is really up to the patient to make a decision whether he / she will follow doctors’ advice.
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