Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines

Abstract

BACKGROUND On the basis of the 2014 guidelines for hypertension therapy in the United States, many eligible adults remain untreated. We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines. METHODS We used the Cardiovascular Disease Policy Model to simulate drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease, and quality-adjusted life-years (QALYs) gained by treating previously untreated adults between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness according to age, hypertension level, and the presence or absence of chronic kidney disease or diabetes. RESULTS The full implementation of the new hypertension guidelines would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. The projections showed that the treatment of patients with existing cardiovascular disease or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years and for women between the ages of 45 and 74 years. The treatment of men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for women between the ages of 45 and 74 years, whereas treating women between the ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease had intermediate or low cost-effectiveness. CONCLUSIONS The implementation of the 2014 hypertension guidelines for U.S. adults between the ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events and 13,000 deaths annually, while saving costs. Controlling hypertension in all patients with cardiovascular disease or stage 2 hypertension could be effective and cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.)

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

“…For reference, our results suggested that if 100% of aware and treated blood pressure above goal was controlled among African American and whites aged 45 to 64 years of age, ≈20 154 CHD events could be prevented annually in the United States, consistent with recently published estimates using the JNC 8 guidelines 24. Despite considerable clinical and public health efforts to improve hypertension management, no historical precedent is available for achieving 100% control; instead, nationally representative estimates suggested that ≈43.5% of adults with treatment‐eligible hypertension are not treated to goal 43.…”

“…The large cardioprotective benefits associated with the medical management of blood pressure led earlier studies to evaluate the hypothetical impact of 100% elimination of hypertension on the incidence of CVD through metrics like the population‐attributable fraction 24, 26. For reference, our results suggested that if 100% of aware and treated blood pressure above goal was controlled among African American and whites aged 45 to 64 years of age, ≈20 154 CHD events could be prevented annually in the United States, consistent with recently published estimates using the JNC 8 guidelines 24.…”

“…The degree to which modest population‐wide blood pressure shifts may affect the incidence of HF also remains unknown, as do the effects of blood pressure shifts in African American populations,19 who shoulder higher burdens of elevated blood pressure as well as CVD than do white populations 1. Further, the majority of published studies estimated cardiovascular benefits from interventions that completely eliminated hypertension or uncontrolled hypertension from the population, despite the implausibility of such goals 24, 25, 26. Therefore, in a biracial, population‐based setting, we assessed the impact of 2 types of pragmatic, hypothetical interventions on reducing the incidence of CHD, stroke, and HF after full implementation: a population‐wide intervention that reduced SBP by 1 or 2 mm Hg and targeted interventions that achieved a 10% reduction in the proportion of the population with unaware, untreated, or uncontrolled blood pressure above goal.…”

The Relationship Between Cognitive Functioning and the JNC-8 Guidelines for Hypertension in Older Adults

“…There have been a number of published commentaries of the JNC-8 guidelines, as well as papers addressing the treatment and economic ramifications (10)(11)(12)(13)(14)(15). However, to our knowledge, only one recent study (16) investigated the implications of these recommendations on cognitive outcomes using the Atherosclerosis Risk in Communities sample.…”

El SPRINT en la práctica médica: ¿es momento de modificar el manejo de la hipertensión arterial en Latinoamérica?

“…En tal sentido consideramos la necesidad de realizar estudios de costo beneficio en relación con los años de vida perdidos ajustados a salud, como los realizados en Chile 51 , y sustentados en función de la GPC utilizada 52 .…”