Lowering Blood Pressure Targets Could Reduce CV Events, Lower Costs

A computer simulation study demonstrates that more intensive blood pressure goals for adults at high risk of cardiovascular disease would prevent up to 43,000 additional deaths from cardiovascular disease each year, as well as decrease overall treatment costs.

The guidelines of the 8^th Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC8), released in 2014, recommended target systolic blood pressure levels of 140 mmHg and 150 mmHg for high-risk adults (those with diabetes and/or chronic kidney disease) and healthy adults aged ≥60 years, respectively. These target levels were substantially lower than those in the 7^th JCN guidelines, released in 2003, which recommended target SBP levels of 130 mmHg and 140 mmHg for these two populations, respectively.

Additionally, recent evidence from SPRINT (Systolic Blood Pressure Intervention Trial) suggested that a more intensive SBP goal of 120 mmHg for high-risk adults reduced both the frequency of cardiovascular events and mortality compared with the goal of 140 mmHg.

To determine the value of using more intensive SBP targets for high-risk adults in combination with the JNC7 or JNC8 targets for healthy adults, researchers from Columbia University Medical Center (New York, NY) performed a computer simulation using data from a national population of adults to evaluate the relative cost-effectiveness of these SBP goals.

According to the model, although achieving the more intensive SBP target for high-risk adults would require treating more patients, and thus would be more costly to implement, this approach would prevent an estimated 43,000 and 35,000 annual cardiovascular events than the JNC8 targets and JNC7 targets, respectively.

Using a willingness-to-pay threshold of $50,000 per quality-adjusted life years gained, the intensive plus JNC8 strategy had the highest probability of cost-effectiveness in women (82%), and the intensive plus JNC7 strategy had the highest probability of cost-effectiveness in men (100%). Overall, assuming higher drug and monitoring costs, the model showed that adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women.

"Our simulation shows that we have everything to gain by taking a more aggressive approach to lowering systolic blood pressure in patients with certain cardiovascular disease risk factors," concluded lead study author Andrew Moran, MD, MPH, in a press release.

Reference

Moise N, Huang, C, Rodgers A, et al. Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35–74 Years [published online ahead of print May 15, 2016]. Hypertension. doi:10.1161/HYPERTENSIONAHA.115.06814.