Aggressive blood pressure target may make financial sense for high-risk patients

Since results of the SPRINT trial were released last year, cardiologists and other healthcare professionals have debated its results. The study found that a systolic blood pressure target of 120 mm Hg reduced the rate of morbidity and mortality by 25 percent in certain patients compared with a standard target of 140 mm Hg.

A recent analysis of that study suggests that intensive blood pressure management may also be cost-effective for adults who are at least 50 years old, have hypertension but do not have diabetes and are at high risk for cardiovascular disease. The results were published online Sept. 14 in JAMA Cardiology.

The researchers noted that patients in the intensive treatment group received more medications and visited physicians more often than the standard treatment group. The absolute event rates were low, as well, with a number needed to treat of approximately 198 to avoid one cardiovascular event or death per year.

To assess the cost-effectiveness of a more aggressive approach, the researchers developed a Markov model that estimated the lifetime costs were $155,261 for standard management and $176,584 for intensive management. The life expectancy was 12.97 years and 14.25 years, respectively.

The model showed that a systolic blood pressure target of 120 mm Hg costs $23,777 per quality-adjusted life-year (QALY) gained, which was well within the typical willingness to pay threshold of $50,000 per QALY gained.

The researchers also used two-way sensitivity analyses to evaluate what happened if serious adverse event rates were higher than expected. For the intensive management to not be cost-effective, serious adverse event rates would need to be three times higher than those observed in the SPRINT trial and be three times more common in the intensive management group compared with the standard management group.

“Increasingly, clinicians are held accountable both for the health of their patients and also the costs of caring for them,” the researchers wrote. “Concerns about costs of treatment and adverse events might temper enthusiasm for intensive blood pressure management, especially given the number needed to treat described in SPRINT. Our analysis indicates that unless adverse events are markedly higher or benefits are substantially lower than observed in SPRINT, intensive blood pressure management is both effective and cost-effective in patients at high cardiovascular risk. These analyses can inform clinicians, provider organizations, and guideline developers as they translate the results of SPRINT into practice.”