Key result
Cuff SBP underestimation of invasive pressure predicts ~12 missed CVD events per 1000 hypertensive patients.
Why the study?
Hypertension management relies on cuff blood pressure, which may be inaccurate and could potentially impact cardiovascular disease events and healthcare costs.
Does cuff systolic blood pressure underestimation compared to invasive aortic measurement increase the predicted number of missed cardiovascular events and related health costs in adults?
Does cuff systolic blood pressure underestimation compared to invasive aortic measurement increase the predicted number of missed cardiovascular events and related health costs in adults?
Underestimation of systolic blood pressure by non-invasive cuff measurements compared to invasive aortic measurements may lead to a significant number of missed, preventable cardiovascular events and increased healthcare costs, particularly in patients with higher grades of hypertension.
Cuff underestimation may miss preventable events and raise costs in severe hypertension; hypothesis-generating for prospective trials of invasive aortic BP assessment.
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.
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Fonseca et al. (2023) studied Hypertension (n=1,678). Cuff systolic blood pressure (SBP) measurement vs. Invasive (intra-arterial) aortic SBP measurement was evaluated on Differences in the number of predicted cardiovascular disease (CVD) events and total CVD health costs. Cuff SBP underestimation of invasive aortic SBP by at least 15 mmHg in patients with grade II and III hypertension can result in up to 11.8 missed CVD events and $241,300 in excess costs per 1000 patients.
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