Do you need to “know your numbers”?
“Know your numbers” was the public catchcry on World Hypertension Day 2011, and doctors were once again admonished to measure their patients’ blood pressure levels. The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom has gone one step further and now recommends that all patients in whom hypertension is suspected be offered ambulatory blood pressure monitoring to confirm the diagnosis.1 A recent report suggested this approach is cost-effective,2 although other research findings suggest that the precise measurement of blood pressure may not be very important when selecting whom to treat.3-4 Indeed, a recent report suggested that age alone might be a sufficient basis for decision making.5 What then is the role of ambulatory blood pressure monitoring in clinical practice?
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- 1. National Institute for Health and Clinical Excellence. Hypertension: clinical management of primary hypertension in adults [clinical guideline 127]. London: NICE, 2011. http://www.nice.org.uk/CG127 (accessed Nov 2011).
- 2. Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet 2011; 378: 1219-1230.
- 3. Bell K, Hayen A, McGeechan K, et al. Effects of additional blood pressure and lipid measurements on the prediction of cardiovascular risk. Eur J Cardiovasc Prev Rehabil 2011; Sep 26. [Epub ahead of print.]
- 4. Law M, Morris J, Wald N. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665. doi: 10.1136/bmj.b1665.
- 5. Wald N, Simmonds M, Morris J. Screening for future cardiovascular disease using age alone compared with multiple risk factors and age. PLoS One 2011; 6: e18742.
- 6. Vickers A, Basch E, Kattan M. Against diagnosis. Ann Intern Med 2008; 149: 200-203.
- 7. Jackson R. Updated New Zealand cardiovascular disease risk-benefit prediction guide. BMJ 2000; 320: 709-710.
- 8. Gaziano TA, Steyn K, Cohen DJ, et al. Cost-effectiveness analysis of hypertension guidelines in South Africa. Absolute risk versus blood pressure level. Circulation 2005; 112: 3569-3576.
- 9. Powers BJ, Olsen MK, Smith VA, et al. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med 2011; 154: 781-788.
- 10. National Vascular Disease Prevention Alliance. Guidelines for the assessment of absolute cardiovascualr disease risk. Melbourne: National Heart Foundation of Australia, 2009. http://www.heartfoundation.org.au/information-for-professionals/Clinical-Information/Pages/absolute-risk.aspx (accessed Nov 2011).
Bruce Neal receives current support or has received support within the past 5 years from a number of pharmaceutical companies marketing blood pressure lowering drugs but has no support from device manufacturers.