Affecting a billion people, hypertension is the cardiovascular risk factor associated with the highest mortality worldwide. There are well-documented problems in the detection of hypertension, as it varies throughout the day and in response to various stimuli. Out-of-office options have been developed that monitor blood pressure either at home or whilst ambulatory, and have been shown to correlate better with cardiovascular prognosis.

Lovibond and colleagues used a Markov model-based probabilistic cost-effectiveness analysis to compare out-of-office blood pressure recording (both ambulatory and home systems) against conventional repeat clinic measurement in a hypothetical primary-care population aged over 40 with a raised screening blood-pressure. The model made predictions on lifetime costs, quality-adjusted life years and cost-effectiveness. Both of the out-of-office approaches were initially slightly more expensive than repeat clinic measurement. However, the increased accuracy in diagnosis of hypertension resulted in ambulatory blood pressure monitoring being more cost-effective in the diagnosis of hypertension in all sub-groups (from –£56 [95% CI –105 to –10] in men aged 75 years to –£323 [95% CI –£389 to –£222] in women aged 40 years) in addition to resulting in more QALYs in the over fifties.

Conclusions:

Following a raised clinic blood pressure reading, the use of ambulatory monitoring to diagnose hypertension is a cost-effective option in all patients as well as resulting in more QALYs in patients over fifty

• Lovibond K, Jowett S, Barton P, Caulfield M, Heneghan C, Hobbs FD, Hodgkinson J, Mant J, Martin U, Williams B, Wonderling D, McManus RJ. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011 Oct 1;378(9798):1219-30. Epub 2011 Aug 23.