Journal ArticleDOI
Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study.
Kate Lovibond,Sue Jowett,Pelham Barton,Mark J. Caulfield,Carl Heneghan,F D R Hobbs,James Hodgkinson,Jonathan Mant,Una Martin,Bryan Williams,Bryan Williams,David Wonderling,Richard J McManus +12 more
- Vol. 378, Iss: 9798, pp 1219-1230
TLDR
Ambulatory monitoring as a diagnostic strategy for hypertension after an initial raised reading in the clinic would reduce misdiagnosis and save costs, and additional costs from ambulatory monitoring are counterbalanced by cost savings from better targeted treatment.Abstract:
Summary Background The diagnosis of hypertension has traditionally been based on blood-pressure measurements in the clinic, but home and ambulatory measurements better correlate with cardiovascular outcome, and ambulatory monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension. We aimed to compare the cost-effectiveness of different diagnostic strategies for hypertension. Methods We did a Markov model-based probabilistic cost-effectiveness analysis. We used a hypothetical primary-care population aged 40 years or older with a screening blood-pressure measurement greater than 140/90 mm Hg and risk-factor prevalence equivalent to the general population. We compared three diagnostic strategies—further blood pressure measurement in the clinic, at home, and with an ambulatory monitor—in terms of lifetime costs, quality-adjusted life years, and cost-effectiveness. Findings Ambulatory monitoring was the most cost-effective strategy for the diagnosis of hypertension for men and women of all ages. It was cost-saving for all groups (from −£56 [95% CI −105 to −10] in men aged 75 years to −£323 [−389 to −222] in women aged 40 years) and resulted in more quality-adjusted life years for men and women older than 50 years (from 0·006 [0·000 to 0·015] for women aged 60 years to 0·022 [0·012 to 0·035] for men aged 70 years). This finding was robust when assessed with a wide range of deterministic sensitivity analyses around the base case, but was sensitive if home monitoring was judged to have equal test performance to ambulatory monitoring or if treatment was judged effective irrespective of whether an individual was hypertensive. Interpretation Ambulatory monitoring as a diagnostic strategy for hypertension after an initial raised reading in the clinic would reduce misdiagnosis and save costs. Additional costs from ambulatory monitoring are counterbalanced by cost savings from better targeted treatment. Ambulatory monitoring is recommended for most patients before the start of antihypertensive drugs. Funding National Institute for Health Research and the National Institute for Health and Clinical Excellence.read more
Citations
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Journal ArticleDOI
European Society of Hypertension Position Paper on Ambulatory Blood Pressure Monitoring
Eoin O'Brien,Gianfranco Parati,George S. Stergiou,Roland Asmar,Laurie Beilin,Grzegorz Bilo,Denis Clement,Alejandro de la Sierra,Peter W. de Leeuw,Eamon Dolan,Robert Fagard,John W. Graves,Geoffrey A. Head,Yutaka Imai,Kazuomi Kario,Empar Lurbe,Jean-Michel Mallion,Giuseppe Mancia,Thomas Mengden,Martin G. Myers,Gbenga Ogedegbe,Takayoshi Ohkubo,Stefano Omboni,Paolo Palatini,Josep Redon,Luis M. Ruilope,Andrew Shennan,Jan A. Staessen,Gert vanMontfrans,Paolo Verdecchia,Bernard Waeber,Ji-Guang Wang,Alberto Zanchetti,Yuqing Zhang +33 more
TL;DR: The historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique are considered, while the role ofABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined.
Journal ArticleDOI
Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association.
Paul Muntner,Daichi Shimbo,Robert M. Carey,Jeanne Charleston,Trudy Gaillard,Sanjay Misra,Martin G. Myers,Gbenga Ogedegbe,Joseph E. Schwartz,Raymond R. Townsend,Elaine M. Urbina,Anthony J. Viera,William B. White,Jackson T. Wright +13 more
TL;DR: Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents and initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
Journal ArticleDOI
KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease
Alfred K. Cheung,Tara I. Chang,William C. Cushman,Susan L. Furth,Fan Fan Hou,Joachim H. Ix,Gregory A. Knoll,Paul Muntner,Roberto Pecoits-Filho,Mark J. Sarnak,Sheldon W. Tobe,Charles R.V. Tomson,Johannes F.E. Mann +12 more
Journal ArticleDOI
Cost-Effectiveness and Clinical Effectiveness of Catheter-Based Renal Denervation for Resistant Hypertension
Benjamin P. Geisler,Brent M. Egan,Joshua T. Cohen,Abigail M. Garner,Ron Akehurst,Murray D. Esler,Jan B. Pietzsch +6 more
TL;DR: The model suggests that catheter-based renal denervation, over a wide range of assumptions, is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality.
Journal ArticleDOI
Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension.
George C. Roush,Robert Fagard,Gil F. Salles,Sante D. Pierdomenico,Gianpaolo Reboldi,Paolo Verdecchia,Kazuo Eguchi,Kazuomi Kario,Satoshi Hoshide,Jorge Polónia,Alejandro de la Sierra,Ramon C. Hermida,Eamon Dolan,Hernan Zamalloa +13 more
TL;DR: In hypertensive patients, NS BP had greater dispersion than DSBP and CSBP in all cohorts, and, overall, NSBP independently predicted CVEs, whereas CSBP and DSBp lost their predictive ability entirely.
References
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Giuseppe Mancia,Guy De Backer,Anna F. Dominiczak,Renata Cifkova,Robert Fagard,Giuseppe Germanò,Guido Grassi,Anthony M. Heagerty,Sverre E. Kjeldsen,Stéphane Laurent,Krzysztof Narkiewicz,Luis M. Ruilope,Andrzej Rynkiewicz,Roland E. Schmieder,Harry A.J. Struijker Boudier,Alberto Zanchetti +15 more
TL;DR: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the management of Arterspertension of the European Society ofhypertension (ESH) and of theEuropean Society of Cardiology (ESC).
Journal ArticleDOI
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
TL;DR: Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
Journal ArticleDOI
Selected major risk factors and global and regional burden of disease
TL;DR: Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated.
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