'White-coat hypertension' could soon be a problem of the past, with MSAC recommending approval for ambulatory monitoring devices.
Ambulatory blood pressure monitoring devices look set to be publicly funded, in a move that could curb both the under- and over-diagnosis of hypertension.
This would have a “huge” impact improving diagnosis and control of hypertension in the community, said Professor Geoff Head, neurophysiologist at the Baker Institute and head of the Ambulatory Working Group of the High Blood Pressure Research Council of Australia.
“That in itself will reduce hospital costs, will reduce strokes and have a huge benefit on the community in lessening hypertension – which is still the major contributor to cardiovascular disease, which is the biggest cause of mortality and morbidity in the community,” Professor Head said.
The Medical Services Advisory Committee (MSAC) recently recommended that the government fund the test, saying it was the “gold standard” for diagnosing hypertension.
MSAC recommends patients be eligible if they had a reading of 140/90mmHg or more and 180/110mmHg or less in the clinic and have not been prescribed antihypertensives before.
Under the proposed criteria, GPs would be able to give these patients the device to wear on their upper arm for 24 hours as part of their daily routine. The new listing is expected to allow for only one such subsidised test per year.
These devices are designed to protect against “white-coat” hypertension, i.e. elevated readings in settings that are more stressful, such as the clinic.
Professor Head said that most people with white-coat hypertension went on to develop true hypertension in time: “So it’s not benign, but it needs to be differentiated.”
“The other big concern is ‘masked’ hypertension,” he said. This occurs when people have normal readings in the clinic, but experience hypertension from stressors such as their work or home life.
Patients may have stopped drinking for a day or two before seeing their doctor, artificially lowering their blood pressure readings.
These two groups make up quite a large number of people missed by conventional diagnostic techniques, he said. Australian research suggests around one in four patients is misdiagnosed when clinic measurements are used.
Ambulatory blood pressure readings are also more predictive of the type of end organ damage associated with hypertension and clinical outcomes than clinic measurements, research suggests.
The device takes one reading every 15 to 30 minutes during the day and every 30 to 60 minutes at night, and patients are encouraged to avoid strenuous exercise and keep a diary of their activities.
The MSAC report recommends GPs receive around $110 for each ambulatory blood pressure monitoring test, which includes a $10 rebate each time a patient receives the device.
The committee recommended against funding for the device’s batteries.
At present, the devices cost around $2500. However, it is possible that manufacturers will loan them to clinics and charge a fee for each use.
Professor Head and his colleagues are now waiting for Health Minister Greg Hunt to give the green light to the new MBS item numbers, although it is uncommon for a health minister to reject a recommendation from the committee.
They anticipate that these item numbers will be approved and available around the end of the year or early 2021.
To read more, visit the government’s website.
