Cardiovascular and health cost impacts of cuff blood pressure underestimation and overestimation of invasive aortic systolic blood pressure

Fonseca R, Palmer AJ, Picone DS, Cox IA, Schultz MG, Black JA, Bos WJ, Cheng HM, Chen CH, Cremer A, Dwyer N, Hughes AD, Lacy P, Omboni S, Ott C, Pereira T, Pucci G, Schmieder R, Wang JG, Weber T, Westerhof BE, Williams B, Sharman JE (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Journal of Hypertension Lippincott, Williams & Wilkins

Book Volume: 41

Pages Range: 1585-1594

Journal Issue: 10

DOI: 10.1097/HJH.0000000000003510

Abstract

OBJECTIVE: Hypertension management is directed by cuff blood pressure (BP), but this may be inaccurate, potentially influencing cardiovascular disease (CVD) events and health costs. This study aimed to determine the impact on CVD events and related costs of the differences between cuff and invasive SBP. METHODS: Microsimulations based on Markov modelling over one year were used to determine the differences in the number of CVD events (myocardial infarction or coronary death, stroke, atrial fibrillation or heart failure) predicted by Framingham risk and total CVD health costs based on cuff SBP compared with invasive (aortic) SBP. Modelling was based on international consortium data from 1678 participants undergoing cardiac catheterization and 30 separate studies. Cuff underestimation and overestimation were defined as cuff SBP less than invasive SBP and cuff SBP greater than invasive SBP, respectively. RESULTS: The proportion of people with cuff SBP underestimation versus overestimation progressively increased as SBP increased. This reached a maximum ratio of 16 : 1 in people with hypertension grades II and III. Both the number of CVD events missed (predominantly stroke, coronary death and myocardial infarction) and associated health costs increased stepwise across levels of SBP control, as cuff SBP underestimation increased. The maximum number of CVD events potentially missed (11.8/1000 patients) and highest costs ($241 300 USD/1000 patients) were seen in people with hypertension grades II and III and with at least 15 mmHg of cuff SBP underestimation. CONCLUSION: Cuff SBP underestimation can result in potentially preventable CVD events being missed and major increases in health costs. These issues could be remedied with improved cuff SBP accuracy.

Authors with CRIS profile

Christian Ott Department of Medicine 4 – Nephrology and Hypertension Roland Schmieder Professur für Innere Medizin (Nephrologie)

Involved external institutions

University of Tasmania (UTAS) AU Australia (AU) Antonius Ziekenhuis Sneek NL Netherlands (NL) Centre Hospitalier Universitaire de Bordeaux / CHU Bordeaux FR France (FR) Royal Hobart Hospital NZ New Zealand (NZ) University College London (UCL) GB United Kingdom (GB) National Institute for Health Research GB United Kingdom (GB) Italian Institute of Telemedicine IT Italy (IT) Escola Superior de Tecnologia da Saúde de Coimbra (ESTSC) PT Portugal (PT) Università degli Studi di Perugia IT Italy (IT) Ruijin Hospital / 上海交通大学医学院附属瑞金医院 / St. Marie Hospital CN China (CN) Klinikum Wels-Grieskirchen AT Austria (AT) Vrije Universiteit Amsterdam (VU) / University Amsterdam NL Netherlands (NL)

How to cite

APA:

Fonseca, R., Palmer, A.J., Picone, D.S., Cox, I.A., Schultz, M.G., Black, J.A.,... Sharman, J.E. (2023). Cardiovascular and health cost impacts of cuff blood pressure underestimation and overestimation of invasive aortic systolic blood pressure. Journal of Hypertension, 41(10), 1585-1594. https://doi.org/10.1097/HJH.0000000000003510

MLA:

Fonseca, Ricardo, et al. "Cardiovascular and health cost impacts of cuff blood pressure underestimation and overestimation of invasive aortic systolic blood pressure." Journal of Hypertension 41.10 (2023): 1585-1594.

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