Adhering to hypertension guidelines could save lives, reduce costs

Fully implementing recent hypertension guidelines for adults ages 35 to 74 could potentially prevent about 56,000 cardiovascular events and 13,000 deaths annually, while saving money, a study found.

Researchers projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines of the Eighth Joint National Committee via the Cardiovascular Disease Policy Model. That model is a computer simulation of drug-treatment and monitoring costs, savings from treating cardiovascular disease, and quality-adjusted life-years (QALYs) gained by treating previously untreated adults from 2014 to 2024.

Results appeared in the Jan. 29 New England Journal of Medicine.

According to the model, about 860,000 persons with existing cardiovascular disease and hypertension who are not being treated with antihypertensive medications would be eligible for treatment (secondary prevention) annually through 2024. Treatment to a target blood pressure of 140/90 mm Hg could prevent about 16,000 cardiovascular events and 6,000 deaths from cardiovascular causes annually, the authors concluded. Another 8.6 million currently untreated patients with hypertension but no cardiovascular disease would also be eligible for treatment (primary prevention) each year. Achieving guideline targets in these patients could prevent about 41,000 cardiovascular events and 7,000 deaths from cardiovascular causes annually and result in cost savings, according to projections.

Treating men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would save money even if strategies to increase medication adherence doubled treatment costs, the authors noted. Treating stage 1 hypertension was cost-effective (defined as less than $50,000 per QALY) for all men and for women between the ages of 45 and 74. But treating women between the ages of 35 and 44 with stage 1 hypertension without cardiovascular disease had intermediate or low cost-effectiveness.

The authors noted that more frequent office visits, home blood-pressure monitoring, pharmacist interventions, or adherence interventions might add substantial value, even at an annual cost 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.

The authors wrote, “Among the groups that we considered, the treatment of men and women with cardiovascular disease and those with stage 2 hypertension without cardiovascular disease appeared to provide the most value, and the treatment of women under the age of 60 years with stage 1 hypertension appeared to provide the least value.”