Empirical Studies of Effects of High Blood Pressure on Medical Costs and Heart Disease: Is the 2017 ACC/AHA Guideline Supported by Enough Evidence?

Nawata, Kan; Kimura, Masaaki

doi:10.4236/health.2018.1011115

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…In the HD model, the ORs (95% CI) were 1.93 (1.83-2.02), 1.81 (1.59-2.04), 2.21 (2.06-2.36), and 2. 19 Odds ratios and 95% confidence intervals of Age (Age 50 vs. Age 70) in three models. Odds ratios and 95% confidence intervals of U_Protein and Weight_1 in three models.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for heart, cerebrovascular, and kidney diseases: evaluation of potential side effects of medications to control hypertension, hyperglycemia, and hypercholesterolemia

Nawata

2023

Front. Cardiovasc. Med.

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BackgroundHeart disease (HD), cerebrovascular disease (CBD), and kidney disease (KD) are serious diseases worldwide. These diseases constitute the leading causes of death worldwide and are costly to treat. An analysis of risk factors is necessary to prevent these diseases.Data and MethodsRisk factors were analyzed using data from 2,837,334, 2,864,874, and 2,870,262 medical checkups obtained from the JMDC Claims Database. The side effects of medications used to control hypertension (antihypertensive medications), hyperglycemia (antihyperglycemic medications), and hypercholesterolemia (cholesterol medications), including their interactions, were also evaluated. Logit models were used to calculate the odds ratios and confidence intervals. The sample period was from January 2005 to September 2019.ResultsAge and history of diseases were found to be very important factors, and the risk of having diseases could be almost doubled. Urine protein levels and recent large weight changes were also important factors for all three diseases and made the risks 10%–30% higher, except for KD. For KD, the risk was more than double for individuals with high urine protein levels. Negative side effects were observed with antihypertensive, antihyperglycemic, and cholesterol medications. In particular, when antihypertensive medications were used, the risks were almost doubled for HD and CBD. The risk would be triple for KD when individuals were taking antihypertensive medications. If they did not take antihypertensive medications and took other medications, these values were lower (20%–40% for HD, 50%–70% for CBD, and 60%–90% for KD). The interactions between the different types of medications were not very large. When antihypertensive and cholesterol medications were used simultaneously, the risk increased significantly in cases of HD and KD.ConclusionIt is very important for individuals with risk factors to improve their physical condition for the prevention of these diseases. Taking antihypertensive, antihyperglycemic, and cholesterol medications, especially antihypertensive medications, may be serious risk factors. Special care and additional studies are necessary to prescribe these medications, particularly antihypertensive medications.LimitationsNo experimental interventions were performed. As the dataset was comprised of the results of health checkups of workers in Japan, individuals aged 76 and above were not included. Since the dataset only contained information obtained in Japan and the Japanese are ethnically homogeneous, potential ethnic effects on the diseases were not evaluated.

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Section: Discussionmentioning

confidence: 99%

“…Many studies have analyzed the relationship between high BP or hypertension [especially high systolic BP (SBP)] and HD or CVD (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Although most of these studies indicated that hypertension is a risk factor for HD and CVD, some questioned the relationship between them (13, 18-20, 22, 23).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for heart, cerebrovascular, and kidney diseases: evaluation of potential side effects of medications to control hypertension, hyperglycemia, and hypercholesterolemia

Nawata

2023

Front. Cardiovasc. Med.

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“…They found a negative relationship between SBP and medical costs. Using the same dataset, Nawata and Kimura ( 37 ) analyzed the effects of BP on medical costs and on the probability of having a history of HD. The dataset was divided into subgroups based on whether the patients had diabetes and took antihypertension medications.…”

Section: Previous Studiesmentioning

confidence: 99%

Heart diseases, hypertension and effects of antihypertensive medications: Is hypertension a true risk factor of heart diseases?

Nawata

2022

Front. Public Health

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BackgroundHeart diseases (HD) are the leading cause of deaths in the world. Many studies have been done on the relationships among hypertension, HD and antihypertensive medications. Most of the studies find that hypertension is a significant risk factor of HD, but there are some studies in which hypertension is not a risk factor. As antihypertensive medications are routinely prescribed to prevent HD, it is necessary to evaluate the effects of these and other risk factors of HD.Data and methodsThe relationship between hypertension and HD was analyzed using 6,773,464 medical checkups obtained from the JMDC Claims Database obtained from January 2005 to September 2019. Factors potentially affecting HD, including blood pressures (BP) and usage of antihypertensive medications, were evaluated using 2,861,769 observations. To avoid the causality problem, probit models were used to analyze the probability of an individual who had no history of HD at year t developing HD by year t + 1.ResultsA positive relation between systolic blood pressure (SBP) and HD was found in the equation without any other covariates. However, the significant relation between HD and BP disappeared when the models contained various other factors as covariates. When a 10-year age or longer interval was used in the model, a positive relation between the two variables was found, suggesting that SBP works as a proxy variable. Taking antihypertensive medications greatly increases the probability of developing HD in the next year. Higher levels of cholesterols decrease the probability of developing HD.ConclusionUnlike many previous studies, no significant relationship between HD and hypertension was found in the models containing multiple covariates. The accepted relation might actually be spurious, and it is important to select covariates carefully. Taking antihypertensive medications appears to increase the probability of developing HD in the next year, suggesting the need for further research and greater caution in the use of antihypertensive medications.

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“…Sample-selection biases and the selection of explanatory variables were other important problems to be properly treated [49].…”

Section: Reviews Of Previous Studiesmentioning

confidence: 99%

“…More recently, Nawata and Kimura[49] [50] analyzed the total annual medical expenditures and results of BP measured using the power transformationTobit models for a dataset containing 175,123 cases obtained from 88,211 individuals. They found that the medical expenditure declined as SBP increased.…”

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An Analysis of the Effects of Blood Pressure and Antihypertensive Drugs on Heart Disease

Nawata¹,

Sugano²,

Kimura³

2019

Health

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Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline (2017 ACA/AHA Guideline) in November 2017. However, other organizations such as the European Society of Cardiology and European Society of Hypertension maintained their diagnostic thresholds. It is necessary to evaluate the effects of blood pressure (BP) and antihypertensive drugs on the probability of having heart disease (HD). Data and Methods: The effects of BP, antihypertensive drugs and other factors on the probability of undergoing HD treatment were analyzed. We used a dataset containing 83,287 medical checkup and treatment records obtained from 35,504 individuals in 5 fiscal years. The probit models were used in the study. Considering the possibility of endogeneity problems, different types of models were used. Results: We could not find evidence that a higher systolic BP increased the probability of undergoing HD treatment. However, diastolic BP increased the probability in most of the models. Taking antihypertensive drugs also increased the probability of undergoing HD treatment. Diabetes was another important risk factor. Conclusion: The results of this study did not support the new 2017 ACC/AHA Guideline. It is necessary to choose proper drugs and methods to reduce the risks of side effects. Limitations: The dataset was observatory, the data were obtained from just one medical society, and sample selection bias might exist.

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Empirical Studies of Effects of High Blood Pressure on Medical Costs and Heart Disease: Is the 2017 ACC/AHA Guideline Supported by Enough Evidence?

Cited by 5 publications

References 29 publications

Risk factors for heart, cerebrovascular, and kidney diseases: evaluation of potential side effects of medications to control hypertension, hyperglycemia, and hypercholesterolemia

Risk factors for heart, cerebrovascular, and kidney diseases: evaluation of potential side effects of medications to control hypertension, hyperglycemia, and hypercholesterolemia

Heart diseases, hypertension and effects of antihypertensive medications: Is hypertension a true risk factor of heart diseases?

An Analysis of the Effects of Blood Pressure and Antihypertensive Drugs on Heart Disease

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