As important as it is to get your blood pressure checked, doing it at the doctor's office is not the best strategy, a new study out of the UK finds. The researchers compared the cost-effectiveness and accuracy of clinical (in-office) blood pressure tests against home blood pressure monitors, and mobile monitors that are worn for 24 hours at a time. The data showed that mobile monitors cost the least, are most likely to catch hypertension early on, and are most likely to prevent other expensive health conditions like cardiovascular disease or organ damage.
The Details: Roughly 10 to 20 percent of adults in the U.S. suffer from "white coat syndrome," which means that their blood pressure spikes when they visit the doctor, leading to inaccurate blood-pressure readings. Which is why patients with high numbers are usually asked to come back once a month for the next three months, so the doctor can get another reading (which means more money). Or a doctor just assumes the patient is nervous and lets it go, leading in some cases to undiagnosed hypertension (or high blood pressure) that can turn into more expensive health problems. In rare cases, a patient may exhibit high blood pressure at the office but not actually have high blood pressure, leading to unnecessary, expensive drugs that come with risky side effects.
The study, published in The Lancet, used computer modeling to see if sending patients home with a mobile blood pressure monitor, usually worn for 24 hours while it takes blood pressure readings every 15 to 30 minutes, would be a better way to get a truly accurate reading for a lower cost. Their findings indicate patients could save as much as $500 if they relied on mobile blood pressure monitoring after a high blood pressure reading. And the savings were higher for younger patients and for women. Home blood pressure monitoring was also a cost saver, but the cost savings were lower overall and were the same for all ages and genders.
What it Means: The costs associated with treating hypertension could be cut significantly if you catch it early on with accurate readings, and the best place to get those readings may not be the doctor's office. But the doctor's office test has become the norm. "Most of us have gotten away from continuous monitoring because when a patient comes to see you, you're measuring blood pressure and how it relates to other things like diabetes, as well," says Myrna Alexander Nickens, MD, FACC, a cardiologist and spokesperson for the American Heart Association. Drugs become the treatment of choice for most cases of hypertension. According to Consumer Reports, costs for blood pressure medications can range from $10 to $120 per month. As a country, we shelled out $76.6 billion in 2010 for health care services related to high blood pressure. Those costs skyrocket if misdiagnosed hypertension turns into heart disease.
"Home blood pressure monitors and mobile monitors do cost more up front, but they can save money if we can diagnose hypertension correctly," she adds. Mobile monitors-the ones that you wear all day-are usually purchased by doctors and can cost upwards of $4,500, but patients (or their insurance companies) pay between $100 and $300 for each use, according to the American Academy of Family Physicians. A good home blood pressure monitor runs $30 to $130, but you can use it for your entire life, avoiding any future costs associated with misdiagnosed hypertension.
Here are a few things to keep in mind if you suffer from white-coat syndrome or think you may have potentially misdiagnosed blood pressure:
• Discuss your options. This new study has caused England's leading medical standards agency to change its guidelines about blood pressure monitoring, making mobile monitors required to prevent misdiagnosis. It isn't clear whether the U.S. will change its guidelines as well. So if you get anxious at your doctor's office and wind up with a high reading, ask about mobile blood pressure monitoring.
• Get a good home monitor. The study's authors, and other physicians, did note that home blood pressure monitors are less accurate than mobile monitors you'd wear for 24 hours. But a recent study found that they more accurately reflect your true blood pressure than blood pressure readings at a clinic.
• Send your blood pressure readings to your doctor. "In my own practice, I have my patients buy their own machine and have them email or send their readings back to me, so I can compare their blood pressure with mine," says Dr. Nickens. That way, she knows if a patient is just nervous or in fact has a serious problem. |
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The Hidden Cost of Blood Pressure Tests