Ambulatory blood pressure monitoring can improve cost-effective management of hypertension

Detection and treatment of arterial hypertension is effective, as shown by clinical trials and downward trends in cardiovascular disease. This process causes expenditures that progressively have increased because of inclusion of more patients with minimally elevated pressure who incur a higher cost of treatment. Average daily pressure is a more accurate predictor of outcome and morbidity than initial screening or occasional clinic monitoring of pressure. Noninvasive ambulatory blood pressure monitoring (ABPM), as a secondary screening, reveals that 20% to 60% of those initially labeled as hypertensive have average daily pressures low enough to delay the initiation of drug therapy. These observations permit the development of forecasting models comparing strategies for management of hypertension. Preliminary estimates show that use of ABPM might reduce the number of patients requiring drug treatment over a 6 year period, with reduced cumulative and yearly costs for this interval. Forecasting models using ABPM now should be tested in comprehensive health care systems to determine their effect on overall cost-effectiveness in the management of hypertension.