Patient Preferences for Pharmaceutical and Device-Based Treatments for Uncontrolled Hypertension: Discrete Choice Experiment

Abstract

BACKGROUND: Discrete choice experiment is a survey method used to understand how individuals make decisions and to quantify the relative importance of features. Using discrete choice experiment methods, we quantified patient benefit–risk preferences for hypertension treatments, including pharmaceutical and interventional treatments, like renal denervation. METHODS: Respondents from the United States with physician-confirmed uncontrolled hypertension selected between treatments involving a procedure or pills, using a structured survey. Treatment features included interventional, noninterventional, or no hypertension treatment; number of daily blood pressure (BP) pills; expected reduction in office systolic BP; duration of effect; and risks of drug side effects, access site pain, or vascular injury. The results of a random–parameters logit model were used to estimate the importance of each treatment attribute. RESULTS: Among 400 patients completing the survey between 2020 and 2021, demographics included: 52% women, mean age 59.2±13.0 years, systolic BP 155.1±12.3 mm Hg, and 1.8±0.9 prescribed antihypertensive medications. Reduction in office systolic BP was the most important treatment attribute. The remaining attributes, in decreasing order, were duration of effect, whether treatment was interventional, number of daily pills, risk of vascular injury, and risk of drug side effects. Risk of access site pain did not influence choice. In general, respondents preferred noninterventional over interventional treatments, yet only a 2.3 mm Hg reduction in office systolic BP was required to offset this preference. Small reductions in office systolic BP would offset risks of vascular injury or drug side effects. At least a 20% risk of vascular injury or drug side effects would be tolerated in exchange for improved BP. CONCLUSIONS: Reduction in systolic BP was identified as the most important driver of patient treatment preference, while treatment-related risks had less influence. The results indicate that respondents would accept interventional treatments in exchange for modest reductions in systolic BP compared with those observed in renal denervation trials.

Diagnosis and management of resistant hypertension

“…Several studies have shown that many patients would prefer renal denervation to taking additional medicine for their high blood pressure. [149][150][151][152] Shared decision making is a necessary component of patient evaluation for this procedure.…”

Renal Denervation as a Complementary Treatment Option for Uncontrolled Arterial Hypertension: A Situation Assessment

“…One problem is that standardised patient-reported outcomes (PRO) measures are lacking for uncontrolled hypertension treatment, whether with medications alone, or following an intervention such as RDN [4]. Important research is being carried out on patient preferences and potential concerns with interventional therapies [83][84][85]. In recent surveys, approximately one-third of hypertensive patients preferred RDN over escalation of medications for BP control [83,84].…”

“…In recent surveys, approximately one-third of hypertensive patients preferred RDN over escalation of medications for BP control [83,84]. Treatment-related risks seem to have less influence on treatment choices than the potential for benefits [85]. Yet it remains unclear to date whether BP reduction represents patients' highest priority or if, e.g., stroke avoidance or pill reduction may be seen as more important.…”

One More Step in the Renal Denervation Trek

“…Second, patients with uncontrolled blood pressure are willing to consider an intervention like renal denervation in lieu of further drug therapy, about three times out of ten [7]. This has been found true in patient preference studies done in Europe [8], Asia [9], and the USA [7].…”

“…Second, patients with uncontrolled blood pressure are willing to consider an intervention like renal denervation in lieu of further drug therapy, about three times out of ten [7]. This has been found true in patient preference studies done in Europe [8], Asia [9], and the USA [7]. These preference studies have also shown that patients and practitioners may have different priorities when making choices designed to improve blood pressure control.…”