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Cost-effectiveness of secondary screening modalities for hypertension

Wang, Y. Clairea; Koval, Alisa M.b; Nakamura, Miyabia; Newman, Jonathan D.c; Schwartz, Joseph E.d,e; Stone, Patricia W.f

doi: 10.1097/MBP.0b013e32835d0fd3
Clinical Methods and Pathophysiology

Background Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or ‘white coat’ hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions.

Materials and methods We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes).

Results We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective.

Conclusion Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.

aDepartment of Health Policy and Management, Columbia Mailman School of Public Health

bMount Sinai School of Medicine

cDepartment of Medicine, Columbia University Medical Center

dCenter for Cardiovascular Behavioral Medicine, Columbia University Medical Center

eDepartment of Psychiatry, Stony Brook University

fColumbia School of Nursing, New York, New York, USA

Correspondence to Y. Claire Wang, MD, ScD, Department of Health Policy and Management, Columbia Mailman School of Public Health, Columbia University, New York, NY 10032, USA Tel: +1 212 305 7359; fax: +1 212 305 3405; e-mail:

Received July 6, 2012

Accepted November 1, 2012

© 2013 Lippincott Williams & Wilkins, Inc.