Implementation of the 2014 hypertension guidelines for U.S. adults aged 35 to 74 years potentially could prevent about 56,000 cardiovascular events and 13,000 deaths yearly, according to a recent study.
Andrew E. Moran, MD, MPH, of Columbia University in New York, and colleagues used the Cardiovascular Disease Policy Model to simulate drug-treatment and monitoring costs, costs averted for treating cardiovascular disease (CVD), and quality-adjusted life-years (QALY) gained by treating previously untreated adults aged 35 to 74 years from 2014 through 2024, assuming that untreated patients would remain untreated. The researchers considered a QALY cost below $50,000 to be cost effective.
“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,” the researchers reported in The New England Journal of Medicine (2015;372;447-455).
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Treatment of men or women with existing CVD or men with stage 2 hypertension but without CVD would remain cost-saving even if strategies to increase medication adherence doubled treatment costs, Dr. Moran’s team stated.
On average, based on 2014 guidelines, about 860,000 individuals with existing CVD and hypertension who are not being treated with anti-hypertension drugs would be eligible for treatment every year during the period from 2014 through 2024. Treatment with a target blood pressure (BP) of 140/90 mm Hg for such patients was projected to prevent about 16,000 cardiovascular events and 6,000 deaths from cardiovascular causes annually.
Another 8.6 million untreated patients aged 35 to 74 years with hypertension but no CVD also would be eligible for treatment each year. Achieving guideline targets in these patients would prevent about 41,000 cardiovascular events and 7,000 deaths from cardiovascular causes annual and result in cost savings compared with the status quo.
Treatment of stage 1 hypertension was cost-effective for all men and for women aged 45 to 74 years. Treating women aged 35 to 44 years with stage 1 hypertension but without cardiovascular disease had low or intermediate cost-effectiveness.
The 2014 guidelines from the Eighth Joint National Committee update 2003 guidelines with 3 important changes: a focus on diastolic rather than systolic pressure in adults younger than 60 years and the establishment of more conservative BP goals for those aged 60 or older (150/90 mm Hg) and for patients with diabetes or chronic kidney disease (140/90 mm Hg).
Compared with 2003 recommendations, the 2014 guidelines would make about 1% young adults and 8% of older adults ineligible to receive BP-lowering treatment, the investigators reported. “However, an estimated 28 million adults still would have uncontrolled hypertension according to the relaxed standards,” they wrote.
The model that the researchers used to make their projections is a computer-simulation, state-transition model of the incidence, prevalence, mortality, and costs of coronary heart disease and stroke among individuals aged 35 to 94 in the United States.
