AMBULATORY BLOOD-PRESSURE MONITORING CAN IMPROVE COST-EFFECTIVE MANAGEMENT OF HYPERTENSION

Detection and treatment of arterial hypertension is effective, as show n by clinical trials and downward trends in cardiovascular disease. Th is process causes expenditures that progressively have increased becau se of inclusion of more patients with minimally elevated pressure who incur a higher cost of treatment. Average daily pressure is a more acc urate predictor of outcome and morbidity than initial screening or occ asional clinic monitoring of pressure. Noninvasive ambulatory blood pr essure monitoring (ABPM), as a secondary screening, reveals that 20% t o 60% of those initially labeled as hypertensive have average daily pr essures low enough to delay the initiation of drug therapy. These obse rvations permit the development of forecasting models comparing strate gies for management of hypertension. Preliminary estimates show that u se of ABPM might reduce the number of patients requiring drug treatmen t over a 6 year period, with reduced cumulative and yearly costs for t his interval. Forecasting models using ABPM now should be tested in co mprehensive health care systems to determine their effect on overall c ost-effectiveness in the management of hyper tension.