Full implementation of new hypertension guidelines could prevent 56,000 cardiovascular disease events — mostly heart attacks and strokes — and 13,000 deaths each year, without increasing overall health care costs, according to an analysis conducted by researchers at Columbia University Medical Center and the Mailman School of Public Health. The paper was published in the online edition of the New England Journal of Medicine.
“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. In fact, we could double treatment and monitoring spending for some patients—namely those with severe hypertension—and still break even,” the authors noted.
To evaluate the impact and cost-effectiveness of implementing the new guidelines, the research team ran a computer simulation — accounting for cost of treatment, savings from reductions in cardiovascular disease (CVD) treatment, and quality-of-life gains — for U.S. adults ages 35 to 74 from 2014 to 2024.
“Given rising health care costs and limited budgets, it’s important to determine the cost-effectiveness of implementing the new guidelines and whether we should focus on specific patient subgroups,” said study leader Dr. Lee Goldman, Mailman school professor of epidemiology and Harold and Margaret Hatch Professor of the University and dean of the faculties of health sciences and medicine at Columbia University Medical Center.
The researchers found that full implementation of the new guidelines would save costs by reducing mortality and morbidity related to CVD. The cost savings were largely driven by favorable results from secondary prevention (measures taken after disease is diagnosed) in patients with CVD and primary prevention (measures taken to prevent disease) in those with stage two, or severe, hypertension. Treating stage one hypertension was cost-effective in all men and women ages 45 to 74.
Curiously, the researchers found that treating women ages 35 to 44 with stage one hypertension and without CVD had intermediate- or low-value cost-effectiveness ratios which warrants further study. Separate research will also look at the cost-effectiveness of hypertension treatment in adults over the age of 74.
“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,” said lead author Dr. Andrew E. Moran, the Herbert Irving Assistant Professor of Medicine and a physician at NewYork-Presbyterian/Columbia.
Stage one hypertension is defined as a systolic BP of 140–159 mm Hg or a diastolic BP of 90–99 mm Hg. Stage two, or severe, hypertension is a systolic BP of 160 mmHg or higher or a diastolic BP of 100 mmHg or higher.
The article is titled, “Cost-effectiveness of hypertension treatment according to 2014 guidelines.” Other contributing institutions: Oregon State University, San Francisco General Hospital, and Partners Health Care.
The study was funded by a grant from the National Heart, Lung, and Blood Institute Award (), an American Heart Association Founder’s Affiliate Clinical Research Program Award (10CRP4140089), a Columbia University Irving scholarship, and a U.S. National Institute for Neurological Disorders and Stroke Award (U54NS081760).