Time to Clinical Benefit of Intensive Blood Pressure Lowering in Patients 60 Years and Older With Hypertension

Chen, Tao; Shao, Fang; Chen, Kangyu; Wang, Yan; Wu, Zhenqiang; Wang, Yongjuan; Gao, Yanpei; Cornelius, Victoria; Li, Chao; Jiang, Zhixin

doi:10.1001/jamainternmed.2022.1657

Cited by 29 publications

(30 citation statements)

References 44 publications

(104 reference statements)

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“…The SPRINT and SPRINT-based cost-effectiveness analyses have provided clinical benefits and good cost-effectiveness. 4 , 5 , 6 , 12 , 14 Nevertheless, the concerns of an intensive target in older patients (SBP <120 mm Hg) may lead to inconsistent SBP targets (ie, 150 mm Hg for the American College of Physicians–American Academy of Family Physicians, 140 mm Hg for the Chinese Geriatrics Society, 130 to 139 mm Hg for the European guidelines, <130 mm Hg for the AHA-ACC guidelines). 7 , 8 , 9 , 10 Compared with SPRINT, despite lacking mortality reduction, less intensive blood pressure control (mean, 130 mm Hg in the STEP trial) for older patients still reduces cardiovascular incidence and showed cost-effective advantages.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a shorter duration of antihypertensive use, higher mortality as a competing risk for CVD, and adherence may influence the health-economic incentive. 12 , 13 Therefore, this study aimed to estimate the lifetime direct medical costs and quality-adjusted life-years (QALYs) of intensive and standard SBP treatments among the older population with hypertension in different countries to examine the cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

“…Although the intensive treatments reduce cardiovascular events compared with the standard treatments, they may simultaneously lead to more adverse events resulting from lower blood pressure and higher medical costs due to increased use of antihypertensive agents, clinic visits, and laboratory monitoring. Moreover, a shorter duration of antihypertensive use, higher mortality as a competing risk for CVD, and adherence may influence the health-economic incentive . Therefore, this study aimed to estimate the lifetime direct medical costs and quality-adjusted life-years (QALYs) of intensive and standard SBP treatments among the older population with hypertension in different countries to examine the cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of Intensive vs Standard Blood Pressure Control Among Older Patients With Hypertension

et al. 2023

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ImportanceOlder patients with hypertension receiving intensive systolic blood pressure control (110-130 mm Hg) have lower incidences of cardiovascular events than those receiving standard control (130-150 mm Hg). Nevertheless, the mortality reduction is insignificant, and intensive blood pressure management results in more medical costs from treatments and subsequent adverse events.ObjectiveTo examine the incremental lifetime outcomes, costs, and cost-effectiveness of intensive vs standard blood pressure control in older patients with hypertension from the health care payer’s perspective.Design, Setting, and ParticipantsThis economic analysis was conducted with a Markov model to examine the cost-effectiveness of intensive blood pressure management among patients aged 60 to 80 years with hypertension. Treatment outcome data from the Trial of Intensive Blood-Pressure Control in Older Patients With Hypertension (STEP trial) and different cardiovascular risk assessment models for a hypothetical cohort of STEP-eligible patients were used. Costs and utilities were obtained from published sources. The incremental cost-effectiveness ratio (ICER) against the willingness-to-pay threshold was used to evaluate whether the management was cost-effective. Extensive sensitivity, subgroup, and scenario analyses were performed to address uncertainty. The US and UK population using race-specific cardiovascular risk models were conducted in the generalizability analysis. Data for the STEP trial were collected from February 10 to March 10, 2022, and were analyzed for the present study from March 10 to May 15, 2022.InterventionsHypertension treatments with a systolic blood pressure target of 110 to 130 mm Hg or 130 to 150 mm Hg.Main Outcomes and MeasuresIncremental lifetime quality-adjusted life-years (QALYs), costs, and ICER are discounted at the given rates annually.ResultsAfter simulating 10 000 STEP-eligible patients assumed to be 66 years of age (4650 men [46.5%] and 5350 women [53.5%]) in the model, the ICER values were ¥51 675 ($12 362) per QALY gained in China, $25 417 per QALY gained in the US, and £4679 ($7004) per QALY gained in the UK. Simulations projected that the intensive management in China being cost-effective were 94.3% and 100% below the willingness-to-pay thresholds of 1 time (¥89 300 [$21 364]/QALY) and 3 times (¥267 900 [$64 090]/QALY) the gross domestic product per capita, respectively. The US had 86.9% and 95.6% probabilities of cost-effectiveness at $50 000/QALY and $100 000/QALY, respectively, and the UK had 99.1% and 100% of probabilities of cost-effectiveness at £20 000 ($29 940)/QALY and £30 000 ($44 910)/QALY, respectively.Conclusions and RelevanceIn this economic evaluation, the intensive systolic blood pressure control in older patients produced fewer cardiovascular events and had acceptable costs per QALY gained, well below the typical willingness-to-pay thresholds. The cost-effective advantages of intensive blood pressure management in older patients were consistent over various clinical scenarios across different countries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of Intensive vs Standard Blood Pressure Control Among Older Patients With Hypertension

et al. 2023

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“… 63 A recent meta-analysis of six randomised clinical trials including 27,400 hypertensive patients (aged ≥60) found that intensive systolic blood pressure lowering (systolic BP < 140 mm Hg) reduced the incidence of major adverse cardiovascular events by 21%. 64 …”

Section: Pharmacotherapymentioning

confidence: 99%

Revisiting secondary prevention in coronary heart disease

Sigamani¹,

Gupta

2022

Indian Heart Journal

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“…An analysis of six trials (original data from two trials and reconstructed data from four trials) that included 27,414 participants demonstrated that intensive BP treatment with a systolic BP target <140 mmHg was significantly associated with a 21% reduction in MACE (HR 0.79; 95% CI [0.71–0.88]; p<0.001). [ 10 ] On average, 9.1 months were needed to prevent one MACE per 500 patients with the intensive BP treatment; in contrast, 19.1 and 34.4 months were estimated to avoid one MACE per 200 and 100 patients with standard treatment, respectively.…”

Section: Intensive Blood Pressure Controlmentioning

confidence: 99%

Most Recent Trials and Advances in Hypertension

Rey-Rañal

Cordero

2022

Eur Cardiol

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Hypertension is one of the most prevalent cardiovascular risk factors and blood pressure control remains a clinical challenge, especially for patients with established cardiovascular disease. Late-breaking clinical trials and other evidence in hypertension have evolved to assess the most accurate ways to measure blood pressure, the use of combination therapies, considerations in special populations and evaluation of new techniques. Recent evidence supports the superiority of ambulatory or 24-hour blood pressure measurements, rather than office blood pressure measurements, for the assessment of cardiovascular risk. The use of fixed-dose combinations and polypills has been demonstrated to be valid and to provide clinical benefits beyond blood pressure control. There have also been advances in new approaches such as telemedicine, devices and the use of algorithms. Clinical trials have provided valuable data on blood pressure control in primary prevention, during pregnancy and in the elderly. The role of renal denervation remains unsolved but innovative techniques using ultrasound or alcohol injections are being explored. Current evidence and results of latest trials are summarised in this review.

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Time to Clinical Benefit of Intensive Blood Pressure Lowering in Patients 60 Years and Older With Hypertension

Abstract: This secondary analysis of randomized clinical trials estimates the time needed to potentially derive clinical benefit from intensive blood pressure treatment in patients 60 years and older.

Cited by 29 publications

References 44 publications

Cost-effectiveness of Intensive vs Standard Blood Pressure Control Among Older Patients With Hypertension

Cost-effectiveness of Intensive vs Standard Blood Pressure Control Among Older Patients With Hypertension

Revisiting secondary prevention in coronary heart disease

Most Recent Trials and Advances in Hypertension

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