Options for the diagnosis of high blood pressure in primary care: a systematic review and economic model
Open accessAbstract
The 2011 NICE hypertension guideline (CG127) undertook a systematic review of the diagnostic accuracy of different blood pressure (BP) assessment methods to confirm the diagnosis of hypertension. The guideline also undertook a cost–utility analysis exploring the cost-effectiveness of the monitoring methods. A new systematic review was undertaken as part of the 2019 NICE hypertension guideline update (NG136). BP monitoring methods compared included Ambulatory BP, Clinic BP and Home BP. Ambulatory BP was the reference standard. The economic model from the 2011 guideline was updated with this new accuracy data. Home BP was more sensitive and specific than Clinic BP. Specificity improved more than sensitivity since the 2011 review. A higher specificity translates into fewer people requiring unnecessary treatment. A key interest was to compare Home BP and Ambulatory BP, and whether any improvement in Home BP accuracy would change the model results. Ambulatory BP remained the most cost-effective option in all age and sex subgroups. In all subgroups, Ambulatory BP was associated with lower costs than Clinic BP and Home BP. In all except one subgroup (females aged 40), Ambulatory BP was dominant. However, Ambulatory BP remained the most cost-effective option in 40-year-old females as the incremental cost-effectiveness ratio for Home BP versus Ambulatory BP was above the NICE £20,000 threshold. The new systematic review showed that the accuracy of both Clinic BP and Home BP has increased. However, Ambulatory BP remains the most cost-effective option to confirm a diagnosis of hypertension in all subgroups evaluated.
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Adoption of HBPM is still challenging because of barriers that involve cultural, structural and financial domains.
“Adoption of HBPM is still challenging because of barriers that involve three general domains: cultural, structural and financial [255–258].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [258]
The Results (Cost-effectiveness analysis update) compare the costs of home, ambulatory and clinic blood-pressure monitoring, while the Clinical conclusions discuss their use in diagnosis. Neither section addresses barriers to adopting HBPM. Searches for cultural, structural and financial barriers and implementation challenges found no passage supporting the claimed three domains. (LLM, conf=0.76)
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Cites
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Research works printed but not linked: 16
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Parati, G., Stergiou, G. S., Bilo, G., Kollias, A., Pengo, M., Ochoa, J. E., Agarwal, R., Asayama, K., Asmar, R., Burnier, M., et al. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002922 · Cited by 178 · see citing works
Self-citation
- Authors
- Constanti, M., Boffa, R., Floyd, C. N., Wierzbicki, A. S., McManus, R. J., & Glover, M.
- Affiliations
- Royal College of Physicians (GB)
- King's College London (GB)
- Guy's Hospital (GB)
- University of Oxford (GB)
- University of Nottingham (GB)
- Corresponding author
- Constanti, Margaret
- ORCID
- Venue
- Journal of Human Hypertension
- Published
- 2020-05-28
- Volume
- 35
- Issue
- 5
- Pages
- 455-461
- ISSN
- 0950-9240 (ISSN-L)
- 1476-5527
- PMC
- PMC8134050
- OpenAlex
- W3029678637
- Cited by
- 21
- References
- 2
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 2 · 2020: 2
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Human Hypertension (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Excellence
- National Institute for Health and Care Research (NIHR200201, NIHR-RP-02-12-015)
- Academy of Medical Sciences (AMS-SGCL5-Glover)
- Medical Research Council (MR/L006162/1)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- hypertension diagnosis, blood pressure monitoring, ambulatory blood pressure monitoring, home blood pressure monitoring, clinic blood pressure measurement, diagnostic accuracy, cost-effectiveness, primary care, unnecessary treatment
- MeSH terms
- Adult, Blood Pressure, Blood Pressure Determination, Female, Humans, Hypertension, Primary Health Care, Blood Pressure Monitoring, Ambulatory, Models, Economic
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