Not testing ambulatory BP ‘could be negligent’

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Calls have been renewed for a Medicare item number for ambulatory blood pressure monitoring


Calls have been renewed for a Medicare item number for ambulatory blood pressure monitoring, as new Australian guidelines recommend it to confirm hypertension, and analysis shows it is cost-effective.

In particular, patients with masked hypertension might be at risk of stroke or other serious consequence of hypertension if their condition was missed because ambulatory monitoring wasn’t used, pharmacologist Professor Geoffrey Head, chair of the Ambulatory Working group of the High Blood Pressure Research Council of Australia, said.

“One could suggest that it is negligent to not use ambulatory monitoring,” Professor Head told TMR.

Under new National Heart Foundation guidelines, ambulatory or home-testing is recommended for patients with an office blood pressure of 140/90mmHg or suspected hypertension.

“The evidence now is very clear cut that ambulatory blood pressure recording or home blood pressure recording are more predictive of outcomes than clinic measures”, Professor Garry Jennings, Heart Foundation chief medical officer, said. “An MBS item number really needs to be looked at”.

And according to Professor Head, not only was there clear and compelling evidence in favour of the superiority of ambulatory monitoring, but several cost-benefit analyses had come out in favour of the test.

One Australian study had found that using ambulatory monitoring for the diagnosis of hypertension in general practice led to a 13% overall cost reduction to the PBS over seven years, he said.

White-coat and masked hypertension could result in misdiagnosis in 20% to 30% of patients evaluated in the clinic, and the costs of ambulatory monitoring were offset in the first year due to a lower rate of unnecessary prescribing, he said.

Patients now pay between $50 and $100 for ambulatory monitoring at a pathology lab, with some offering concession rates as low as $30, Professor Head said.

While the college has been broadly supportive of ambulatory BP monitoring, it had previously cited costs of training staff as one reason not to push for a rebate.

Dr Evan Ackerman, chair of the RACGP National Standing Committee for Quality Care said there was no doubt GPs should be encouraging home BP monitoring, but said it was only one step in a full cardiovascular assessment.

“I think a better idea is for a MBS payment for a full cardiovascular risk assessment every five years with a patient’s usual GP. This would include red book-approved measures, pathology screening, as well as home BP monitoring if necessary,” he said.

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