(RxWiki News) New guidelines have raised blood pressure targets for some, but millions still have uncontrolled blood pressure. Increasing treatment to meet these new targets may save lives and money.
A new study has suggested that taking simple, cost-effective measures to meet these new guidelines may significantly reduce heart attacks, strokes and heart-related deaths. These measures include frequent doctor visits, tracking blood pressure at home, pharmacist interventions and efforts to improve adherence to blood pressure treatment.
Adam Powell, PhD, Partner and President of Payer+Provider, a consulting firm in Boston, told dailyRx News that he's not suprised that it's cost-effective to manage blood pressure in patients diagnosed with hypertension.
"The interventions required are rather low cost," Powell said. "Home blood pressure monitoring requires the purchase of a modestly priced device. Even more frequent hypertension-related office visits are likely to be economical, as they may be conducted in an outpatient setting and do not necessarily involve a physician. If a patient has a stroke, the resulting costs will likely include inpatient care from specialist physicians and even extended rehabilitation. As a result of these cost differences, a prevention strategy is likely to be both lower cost and better quality."
Andrew E. Moran, MD, assistant professor of medicine at Columbia University Medical Center and a doctor at New York-Presbyterian/Columbia Hospital, and colleagues conducted this research.
"Our findings clearly show that it would be worthwhile to significantly increase spending on office visits, home blood pressure monitoring, and interventions to improve treatment adherence," Dr. Moran said in a press release. "In fact, we could double treatment and monitoring spending for some patients — namely those with severe hypertension — and still break even."
For years, the American Heart Association has defined high blood pressure for all adults as a reading of 140 over 90 or higher. In 2014, experts appointed by the National Heart, Lung and Blood Institute (NHLBI) suggested higher blood pressure limits for some. For adults age 60 and older with high blood pressure, the recommended reading was 150 over 90.
Even using the easier-to-reach goals, many still have high blood pressure.
Dr. Moran and team estimated that, even with the more relaxed blood pressure goals, about 44 percent of US adults have high blood pressure that is not controlled enough. That’s about 28 million people.
These new guidelines still maintain that a blood pressure of 140 over 90 or less should be the goal for people younger than 60. They also recommend, however, that medication for high blood pressure be given only when pressure reaches 150 over 90 and beyond in people older than 60. This new higher threshold could mean millions would no longer have to take blood pressure medication.
In a blood pressure reading, the top number is called systolic pressure and measures the pressure in the arteries when the heart beats (when the heart muscle contracts). The bottom number is called diastolic pressure and measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).
The panel that wrote these new guidelines said that health care providers should regularly assess blood pressure, encourage lifestyle and adherence interventions, and adjust treatment until a target blood pressure is reached and maintained.
The researchers in this study set out to estimate the cost-effectiveness of putting the new guidelines in place. They ran a computer simulation drawing on data from the National Health and Nutrition Examination Surveys 2007 to 2010. They analyzed cost of treatment, savings from reductions in heart disease treatment, and quality-of-life gains for previously untreated hypertensive US adults aged 35 to 74 from 2014 to 2023.
Dr. Moran and team found that these new blood pressure guidelines could prevent 56,000 heart disease events (mostly heart attacks and strokes) and 13,000 deaths each year.
These guidelines would not increase overall health care costs, Dr. Moran and colleagues said. In fact, they noted that increased treatment of severe high blood pressure would be particularly cost-effective.
"The overall message of our study is that every segment of our health care system, from small medical practices to large insurance companies, can benefit by improving treatment of hypertension," Dr. Moran said in a press release.
This study was published Jan. 28 in The New England Journal of Medicine.
The research was funded by an NHLBI award, an American Heart Association Founder’s Affiliate Clinical Research Program Award, a Columbia University Irving scholarship, and a National Institute for Neurological Disorders and Stroke award. One author, Dr. Kirsten Bibbins-Domingo, is a member of the US Preventive Services Task Force.
