New York—Allowing higher blood pressure readings for specific high-risk patients was a move in the wrong direction by practice guidelines, according to a new study offering evidence that lowering blood pressure goals for such adults could save numerous lives and reduce healthcare expenditures.
The research, published online by the journal Hypertension and presented at the American Society of Hypertension Annual Scientific Meeting in New York, was based on a computer simulation designed by researchers at Columbia University Medical Center and New York-Presbyterian Hospital.
Study authors say they hope their results will help lead to a revision of national hypertension treatment guidelines, which had loosened in recent years, especially since they are in line with recent evidence from the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT found that having a more intensive systolic blood pressure (SBP) goal of 120 mmHg in patients at high risk for cardiovascular disease reduced both cardiovascular events and mortality by about one quarter, compared with the current goal of 140 mmHg.
New guidelines were issued in 2014 by the 8th Joint National Committee (JNC8) on
Detection, Evaluation, and Treatment of High Blood Pressure, recommending that physicians aim for an SBP of 140 mmHg in adults with diabetes and/or chronic kidney disease and 150 mmHg in healthy adults 60 or older. Previous JNC7 guidelines had recommended SBPs of 130 mmHg and 140, mmHg for these groups, respectively.
The study team conducted the computer simulation, projecting from 2016 to 2026, to determine the value of adding the lower SBP goal identified in SPRINT to the JNC7 and JNC8 guidelines for high-risk patients—i.e., those with existing cardiovascular disease, chronic kidney disease, or a 10-year cardiovascular disease risk greater than 15% in patients older than 50 years and with a pretreatment SBP greater than 130 mmHg—between the ages of 35 and 74 years old.
Results indicate that lowering treatment goals for this population in the JNC8 guidelines would prevent up to 43,000 additional deaths from cardiovascular disease each year, while adding more intensive goals to the JNC7 guidelines would prevent an additional 35,000 deaths.
“At a willingness-to-pay threshold of $50,000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%),” the study authors write. “Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women.”
Keeping medication costs down is a key element of the model, according to the report.
“Hypertension treatment is cheap and effective, and fear of side effects should not dissuade physicians from treating to lower goals in high-risk individuals under 75 years of age,” lead author Nathalie Moise, MD, MS, explained in a Columbia University Medical Center press release. “Containing drug costs will be integral to affordable implementation of intensive blood pressure goals in this high-risk group."
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