According to current estimates, 44% of the 64 million adults in the United States with hypertension did not have their condition controlled in 2014. In 2014, the Eighth Joint National Committee released its first updated guidelines on hypertension since 2003. Several important changes were made from the earlier guideline, including recommendations to focus on diastolic rather than systolic blood pressure (BP) for adults younger than 60 and setting more conservative BP goals for adults aged 60 and older (150/90 mm Hg) as well as for patients with diabetes or chronic kidney disease (140/90 mm Hg).
Estimating Cost Effectiveness
“Few analyses have examined the health benefits and cost-effectiveness of treating hypertension in the U.S.,” says Andrew E. Moran, MD, MPH. To address this research gap, Dr. Moran and colleagues published a study in the New England Journal of Medicine that sought to estimate the incremental health gains and cost-effectiveness of implementing the strongest recommendations for hypertension therapy in the 2014 guidelines among adults.
Using the Cardiovascular Disease Policy Model, the study team simulated drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease (CVD), and quality-adjusted life-years gained by treating previously untreated adults between the ages of 35 and 74 from 2014 through 2024. “Our model pulled together data from many studies to quantify the value of treating hypertension,” adds Dr. Moran. “This information is important for policy-makers and physicians to determine if controlling hypertension is a worthwhile investment.”
Big Rewards for Achieving Goals
The study found that, on average, about 860,000 people with existing CVD and hypertension who are not being treated with antihypertensive medications would be eligible for secondary prevention every year from 2014 through 2024. Full implementation of the new hypertension guidelines would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which in turn would result in overall cost savings (Table).
According to the study projections, treatment of men or women with existing CVD or men with stage 2 hypertension but without CVD would still be cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective for all men and women between the ages of 45 and 74 years (Figure). However, treating women between the ages of 35 and 44 years with stage 1 hypertension but without CVD had intermediate or low cost effectiveness.
“Our model predicted that achieving the hypertension treatment goals outlined in the 2014 guidelines would be cost-saving because it will reduce mortality and morbidity from CVD in hypertensive patients who were previously untreated,” Dr. Moran says. “By controlling high blood pressure, we can have a significant impact on improving overall health, while at the same time, saving money.”
The study results imply that it is important to invest in strategies to reduce the burden of hypertension, including more frequent office visits, home BP monitoring, pharmacist interventions, and sustained efforts to improve adherence. The study notes that these actions may add substantial value, even if they require an additional annual investment of up to $1,230 per patient in men with CVD, $600 in men with stage 2 hypertension without CVD, and $650 in women with CVD.
“We need to focus our efforts on motivating patients to take measures to lower their BP,” Dr. Moran says. “Hypertension is often asymptomatic for years, so it’s important to make sure patients understand that they need to adhere to their medication regimens as prescribed in order to reap the long-term benefits. Taking a team approach—including physicians, nurses, pharmacists, and others—is critical to enhancing the traditional approach to hypertension management. Many patients need a support system in place in order to adhere to their medications.”
Despite the gains that have been made in caring for hypertension, there are still about 28 million adults who have uncontrolled hypertension. “Treating hypertension has become a national priority, but we need more data on how best to manage older patients,” says Dr. Moran. “Our study also suggested that treating women younger than 60 with stage 1 hypertension provided the least value, but this finding might change if our projections accounted for the effects of high BP over several decades. With more research in these areas, there is hope that we can learn more about the value of improving the use of guideline-recommended therapies for hypertension.”
Moran AE, Odden MC, Thanataveerat A, et al. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med. 2015;372:447-455. Available at: http://www.nejm.org/doi/full/10.1056/NEJMsa1406751#t=article.
Navar-Boggan AM, Pencina MJ, Williams K, Sniderman AD, Peterson ED. Proportion of US adults potentially affected by the 2014 hypertension guideline. JAMA. 2014;311:1424-1429.
James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-520.
Go AS, Bauman MA, Coleman King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014;63:878-885.
Cutler DM, Long G, Berndt ER, et al. The value of antihypertensive drugs: a perspective on medical innovation. Health Aff (Millwood). 2007;26:97-110.