Treating uncontrolled hypertension makes dollars and sense

Implementing 2014 hypertension guidelines could save lives and money. A cost analysis study found that full implementation of hypertension guidelines could save 13,000 people from cardiovascular-related deaths and prevent 56,000 cardiovascular events annually.

The study, published online Jan. 28 in the New England Journal of Medicine, explored the cost and effect of implementing hypertension guidelines issued by the Eighth Joint National Committee. These guidelines suggest a focus on diastolic instead of systolic blood pressure in adults under 60, setting blood pressure goals of 150/90 mm Hg for patients over 60, and a goal of 140/90 mm Hg for patients with chronic kidney disease or diabetes. While this means approximately 1 percent of young adults and 8 percent of older adults would be ineligible for hypertensive treatment, an estimated 28 million adults would still require treatment for uncontrolled hypertension.

With this in mind, Andrew W. Moran, MD, MPH, of Columbia University Division of General Medicine at Presbyterian Hospital in New York City, and colleagues developed the Cardiovascular Disease Policy Model to simulate the consequences of instituting these changes on risk and healthcare costs. The data for the analysis were derived from pooled results of antihypertensive trials.

Among patients without cardiovascular disease, they found that the most cost-saving strategies achieved treatment goals for all male patients with stage 2 hypertension, female patients between 45 and 74 with stage 2 hypertension and in men 45 years and older with stage 1 hypertension. Treatment for men 33 to 44 years with stage 1 hypertension with or without diabetes or chronic kidney disease and women with stage 1 hypertension with or without diabetes who were 45 years or older was cost-effective. Treating women with stage 1 hypertension under the age of 45 was, however, the least cost effective strategy.

They defined stage 1 hypertension as 140 to 159 mm Hg and stage 2 hypertension as systolic blood pressure at or higher than 160 mg Hg.

“These findings suggest that more frequent office visits, home blood-pressure monitoring, pharmacist interventions, or interventions to improve adherence may add substantial value, even if they require an additional annual investment of up to $1,230 per patient in men with cardiovascular disease, $600 in men with stage 2 hypertension without cardiovascular disease, and $650 in women with cardiovascular disease,” Moran et al wrote.