CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

August 24th, 2011

Ambulatory BP Monitoring Gains NICE Recommendation in UK

Ambulatory blood pressure (ABP) monitoring is receiving a strong endorsement in the UK from NICE (National Institute for Health and Clinical Excellence). The recommendation is based on a cost-effectiveness study published in the Lancet.

Kate Lovibond and colleagues found that compared with additional measurements in the clinic or home measurements, ABP monitoring was highly cost-effective in patients 40 years or older with a screening blood pressure measurement over 140/90 mm Hg. The results were consistent in men and women, across all age groups, and across a broad range of assumptions.

In most subgroups, ABP monitoring both improved health and reduced costs, the authors reported. For men and for women over 50, the use of ABP resulted in cost savings, prompting the investigators to write that ABP monitoring “was the dominant strategy for men and women of most ages.”

The savings in cost were largely due to the greater specificity of ABP, resulting in fewer people undergoing treatment. The authors concluded that “for most people” ABP monitoring ” should be seriously considered” before antihypertensive treatment is initiated.

In a Lancet press release, senior author of the paper, Richard McManus said that “ambulatory monitoring allows better targeting of blood pressure treatment to those who will receive most benefit.  It is already undertaken in some general practices and whilst implementation on a wide scale will need to be phased in to allow training and acquisition of new equipment, it is cost saving in the long term as well as more effective and so will be good for patients and doctors alike.”

Categories: General, Prevention
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2 Responses to “Ambulatory BP Monitoring Gains NICE Recommendation in UK”

  1. Harlan M. Krumholz, MD, SM says:
    August 24, 2011 at 7:30 pm

    So will they abandon office-based blood pressure measurements as a way to diagnose hypertension in the UK??

  2. Leon Hyman, Ms M.D. says:
    August 26, 2011 at 9:29 pm

    scenarios where ambulatory BP would be ridiculous and delay proper care are a 51 year old man with a BP of 170/110, LVH on the EKG and grade 2 changes in the retina, or a 31 year old man with a BP of 320 /190 and pappilidema of the retina. The latter is an actual case I did the first evaluation in the hypertension clinic at the UN. of Michigan in 1958.The next day he had a Splanchectomy and a month late on 0.25mg of reserpine his BP was 140/90. This was just before chlorthiazide reached the market.

    Competing interests pertaining specifically to this post, comment, or both:
    none