Diagnosis and management of hypertension: around-the-clock ambulatory blood pressure monitoring is substantially more effective and less costly than daytime office blood pressure measurements

ABSTRACT

The cost-effectiveness of ambulatory blood pressure (BP) monitoring (ABPM) versus traditional office BP measurement (OBPM) for the diagnosis and management of hypertension has been evaluated only by few studies and based solely on the reduction of medical care expenses through avoiding treatment of isolated-office hypertension. Data from the 21963 participants in the Hygia Project, a multicenter outcomes study that incorporates into routine primary care periodic, at least yearly, 48 h ABPM evaluation, were utilized to assess the cost-effectiveness – relative to vascular pathology expenditures countrywide in Spain – of ABPM versus OBPM. The actual reported Spanish healthcare expenditure for vascular pathology in 2015 – aggregate costs of medical examinations, outpatient and inpatient care, therapeutic interventions, plus non-healthcare services (productivity losses due to morbidity/mortality and informal family/friends-provided care) – was used to compare yearly costs when diagnostic and treatment decisions for hypertension are based on the OBPM versus the ABPM-model. Our economic analysis is based on the more realistic and feasible approach of restricting ABPM solely to high-risk individuals of age ≥60 years and/or with diabetes, chronic kidney disease, and/or previous cardiovascular event, who in the Hygia Project accounted for >90% of all documented events. The projected net benefit countrywide in favor of the proposed ABPM-model is ~5294M€/year, i.e., 360.33€/year (95%CI [347.52–374.85]) per ABPM-evaluated person. This highly conservative economic analysis indicates ABPM is a much more cost-effective strategy than repeated OBPM not only for accurate diagnosis and management of true hypertension but marked reduction of expenditures on elevated BP-associated vascular pathology.

KEYWORDS:

• Ambulatory blood pressure monitoring
• cardiovascular risk
• diabetes
• chronic kidney disease
• asleep blood pressure
• cost-effective analysis
• healthcare economics

Conflict of interest

All authors have shares and belong to the scientific committee of Circadian Ambulatory Technology & Diagnostics (CAT&D), a technology-based company developed by and in partnership with the University of Vigo.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The Hygia Project is an independent investigator-promoted research network supported by unrestricted grants from Ministerio de Ciencia e Innovación, Spanish Goverment [SAF2009-7028-FEDER]; Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Spanish Government [PI14-00205]; Consellería de Economía e Industria, Dirección Xeral de Investigación e Desenvolvemento, Galician Regional Government [INCITE08-E1R-322063ES; INCITE09-E2R-322099ES; 09CSA018322PR; IN845B-2010/114]; Consellería de Cultura, Educación e Ordenación Universitaria, Galician Regional Government [CN2012/251; GPC2014/078; ED431B-2017/78]; European Regional Development Fund (ERDF) and the Galician Regional Government under agreement for funding the Atlantic Research Center for Information and Communication Technologies (AtlantTIC); and Vicerrectorado de Investigación, University of Vigo. This funding body has no role in the study design, analysis and interpretation of data, writing of the reports, or the decision to submit articles for publication. A complete list of the Hygia Project investigators has been provided elsewhere (Hermida 2016; Hermida et al. 2018).