A white doctor coat and hypertension
Patients newly diagnosed with hypertension may simply be suffering white-coat hypertension, and substantial savings can be made by monitoring rather than treating these people, according to a study in the latest issue of the Medical Journal of Australia.
Sixty-two patients newly diagnosed by their GPs as having hypertension (with a median blood pressure of 154/98mmHg) were monitored by 24-hour ambulatory blood pressure monitoring (ABPM) before initiating drug treatment.
The study revealed that 16 patients (26 percent) had normal average blood pressure on ABPM and did not require drug treatment.
Study authors, Dr Ben Ewald, Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, and Ms Brita Pekarsky, University of Adelaide, highlight the savings made through not treating white coat hypertension with the costs of ABPM of every newly diagnosed hypertensive patient.
"The average government cost per patient over seven years is $317 per year for the "treat all" strategy compared to $294 for the monitoring strategy in which all patients have ABPM initially and it is repeated annually in those not on treatment," Dr Ewald said.
"Our sensitivity and threshold analyses demonstrate that monitoring, although more expensive in the first year, becomes cost neutral after three years and cost saving thereafter."
"It is not often in medicine that a new test will lead to cost savings," Dr Ewald said.
Dr Ewald said a strength of this study is that GPs were asked to decide on conventional grounds that drug treatment was indicated before ordering ambulatory monitoring.
"These patients were all about to commence drug treatment, so the result reflects the realities of current Australian practice.
Dr Ewald said an alternative strategy to detect white-coat hypertension is home monitoring with semi-automated devices, which involves cheaper equipment and more time teaching the patient the method.
In an editorial in the same issue of the MJA, Professor Barry McGrath, Monash University and Dandenong Hospital, Melbourne, said this cost analysis is the first such study based on Australian data.
"Perhaps the most important and challenging finding to emerge from ambulatory blood pressure research has been the detection of white-coat hypertension (also known as isolated clinic hypertension)," Professor McGrath said.
"For people with white coat hypertension and no evidence of cardiovascular disease or comorbidities such as diabetes or renal disease, most experts agree that the best policy is to monitor their clinic blood pressure regularly, with self-monitoring at home, and repeat ABPM at one- to two-yearly intervals."
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACTS: Dr Ben Ewald (02) 4985 5124 (B/H) Thur/Fri PM
(Research) (02) 4929 6599 (A/H)
Professor Barry McGrath (03) 9554 8022 (B/H)
(Editorial) (03) 9882 1813 (A/H)
(0414) 288 030 (A/H)
Sarah Crichton, AMA (0419) 440 076