NICE backs 'cost-saving' ambulatory monitoring for diagnosing hypertension

Updated NICE BP guidance recommending ambulatory monitoring before diagnosing primary hypertension will save the NHS millions of pounds, NICE believes.

NICE guidlines on ambulatory monitoring will lower the risk of overdiagnosis and so reduce GP workload and prescribing costs (Photograph: SPL)
NICE guidlines on ambulatory monitoring will lower the risk of overdiagnosis and so reduce GP workload and prescribing costs (Photograph: SPL)

In updated guidelines, NICE recommends that a diagnosis of primary hypertension should be confirmed using 24-hour ambulatory BP monitoring.

The new diagnostic criteria will lower the risk of overdiagnosis and so reduce GP workload and prescribing costs. A costing analysis presented alongside the guideline and published in The Lancet suggests that that the diagnostic criteria would be cost-saving within a year.

Within five years, a practice with 10,000 patients would save £2,000 a year and the NHS in England would be saving £10m a year, the analysis suggests.

Savings have been estimated based on a cost of £1,000 per ambulatory monitor. However, NICE expects prices of these devices to roughly halve as their use becomes more widespread.

Professor Bryan Williams of the University of Leicester, who helped developed the guidelines, said he expected that in some areas consortia, rather than practices, would buy ambulatory monitors.

NICE does not expect the guidelines to be followed immediately, but said it would expect the new recommendations to implemented within 'the next year or so'.

The revised recommendations contain no major changes to the treatment thresholds and targets, but the treatment algorithm has been simplified.

Birmingham GP Professor Richard McManus, who is professor of primary care cardiovascular research at University of Birmingham, also helped developed the guidelines. He said the guidelines marked ‘a significant change’ in the hypertension is diagnosed.

‘The use of ambulatory monitoring will ensure quicker and more accurate diagnosis that will be better for patients and better for the NHS,’ he said. ‘This represents an exciting advance which I am sure will be taken up internationally.’

The guidelines recommend a calcium channel blocker as the first pharmacological agent for patients aged over 55 years or of African or Caribbean family origin and an ACE inhibitor or angiotensin II receptor blocker (ARB) for patients under 55 years.

The updated recommendations, 'Clinical management of primary hypertension in adults', are available on the NICE website and replace NICE clinical guideline 34.

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