New Hypertension Guidelines Found To Be Cost-Effective

Andrew Moran, MD, MPH Herbert Irving Assistant Professor of Medicine Columbia University Division of General Medicine Presbyterian Hospital 9th floor East room 105 New York, NY 10032MedicalResearch.com Interview with:
Andrew Moran, MD, MPH
Herbert Irving Assistant Professor of Medicine
Columbia University Division of General Medicine
Presbyterian Hospital  New York, NY 10032

Medical Research: What is the background for this study? What are the main findings?

Response: In 2014, a panel appointed by the Eighth Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure (JNC 8) recommended new guidelines for high blood pressure (hypertension ) treatment in U.S. adults.  The guidelines made sweeping changes to the prior guidelines and stirred up controversy among hypertension and public health experts.  Essentially, the panel recommended more conservative treatment targets that narrowed the population eligible for treatment with blood pressure-lowering medications.  Nonetheless, about 28 million U.S. adults have uncontrolled hypertension even under the new more conservative guidelines.  We asked the question:  are the new guidelines cost-effective? That is, does treating this common condition with the available medicines add more health and reduce medical costs?  It is surprising that this question has rarely been answered before.

Medical Research: What should clinicians and patients take away from your report?

Dr. Moran: The bottom line is that despite the costs of medications, monitoring, and side effects, controlling hypertension is cost-saving among patients with existing cardiovascular disease and among patients without cardiovascular disease, and with the most severe hypertension (stage 2 hypertension; blood pressure ≥160/100 mmHg). So cost-saving in fact, that a health organization can probably invest more resources into getting blood pressure controlled in these patients and still break even in terms of costs.

There was more uncertainty in our results for younger patients and those with less severe hypertension (stage 1 hypertension; blood pressure ≥140/90 mmHg but < 160/100 mmHg).  Treating hypertension appeared to be cost-effective in most of these patients, but possibly of low value in low-risk younger women with hypertension.  However, it is important to note that our analysis did not account for  negative effects of high blood pressure that may accumulate in younger patients over decades.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Moran: The major controversies surrounding the changes recommended by the JNC 8 committee can only be answered by more research.  Specifically, we need to learn more about which older patients and patients with diabetes or chronic kidney disease can benefit from more aggressive medication treatment?  Whom among them do we put at risk with more aggressive treatment?

We need to learn more about the long term effects of high blood pressure in younger adults with hypertension.  It is unlikely that we will see the launch of a medication treatment trial lasting decades, so the question of prevention in younger adults will need to be answered using different research approaches.

Perhaps more important than either of these areas of controversy is the simple fact that we have a long way to go toward improving hypertension control in our country.  There have been encouraging signs:  studies performed in real-world clinical practice that have demonstrated that teams of health care providers and pharmacists and/or home blood pressure monitoring can dramatically improve control.  More of these “pragmatic” studies of hypertension control are urgently needed, especially among socially and economically disadvantaged populations.

Citation:

Andrew E. Moran, M.D., M.P.H., Michelle C. Odden, Ph.D., Anusorn Thanataveerat, M.P.H., Keane Y. Tzong, M.P.H., Petra W. Rasmussen, M.P.H., David Guzman, M.S.P.H., Lawrence Williams, M.S., Kirsten Bibbins-Domingo, Ph.D., M.D., Pamela G. Coxson, Ph.D., and Lee Goldman, M.D., M.P.H.

N Engl J Med 2015; 372:447-455January 29, 2015DOI: 10.1056/NEJMsa1406751

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MedicalResearch.com Interview with: Andrew Moran, MD, MPH (2015). Are the New Hypertension Guidelines Cost-Effective? MedicalResearch.com

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