Ambulatory blood pressure monitoring: Is it cost-effective?

The detection and treatment of hypertension can prevent cerebrovascular disease and, to some extent, coronary heart disease. For mild hypertension this process is not efficient because many patients must be treated with antihypertensive medication to benefit only a few. The costs of identification, diagnosis and drug treatment of mild hypertension are significant. These costs have increased recently, in part due to changing patterns of drug selection favoring newer agents. Primary and secondary screening for hypertension has relied on casual blood pressure measurement which has high sensitivity, but low specificity, i.e. many false-positives can be expected. Incorporation of ambulatory blood pressure monitoring into secondary screening has potential for greater specificity by excluding from treatment 20-40% of those initially identified as having mild hypertension. Computer analysis of simulated populations selected for treatment by either casual blood pressure or by use of ambulatory blood pressure monitoring with echocardiography (for borderline cases) demonstrates no difference in calculated life expectancy for the two groups. However, the former strategy selected 23% of the subjects for treatment, while the latter selected 6%. These results imply that appropriate use of ambulatory blood pressure monitoring in secondary screening of mild hypertension may have a significant impact on cost-effectiveness.