19 May Lower Blood Pressure Goals Would Save Lives and Money
MedicalResearch.com Interview with:
Dr. Nathalie Moise
Nathalie Moise, MD, MS
Assistant Professor
Center for Behavioral Cardiovascular Health
Department of Medicine
Columbia University Medical Center
New York, NY 10032
MedicalResearch.com: What is the background for this study?
Dr. Moise: Our research aimed to compare the number of lives saved and changes in medical costs expected if intensive blood pressure goals of less than 120 mmHg were implemented in high cardiovascular disease risk patients.
In 2014, the 8th Joint National Committee (JNC8) on Detection, Evaluation, and Treatment of High Blood Pressure issued new guidelines recommending that physicians aim for a systolic blood pressure (SBP) of 140 mmHg in adults with diabetes and/or chronic kidney disease and 150 mmHg in healthy adults over age 60. The new guidelines represented a major departure from previous JNC7 guidelines recommending SBPs of 130 mmHg and 140, mmHg for these groups, respectively. Under the 2014 guidelines, over 5 million fewer individuals annually would receive drug treatment to lower their blood pressure, compared with the prior 2003 guidelines.
Recently, the Systolic Blood Pressure Intervention Trial (SPRINT) found that having a more intensive systolic blood pressure (SBP) goal of 120 mmHg in patients at high risk for cardiovascular disease reduced both cardiovascular events and mortality by about one quarter, compared with the current goal of 140 mmHg.
These recent studies and guidelines have created uncertainty about the safest, most effective and high-value blood pressure goals for U.S. adults with hypertension, but no prior study has compared the cost-effectiveness of adding more intensive blood pressure goals in high cardiovascular disease risk groups to standard national primary prevention hypertension guidelines like JNC8 and JNC7.
Our team at Columbia University Medical Center conducted a computer simulation study to determine the value of adding the lower, life-saving systolic blood pressure goal identified in SPRINT to the JNC7 and JNC8 guidelines for high-risk patients between the ages of 35 and 74 years. (High risk was defined as existing cardiovascular disease, chronic kidney disease, or a 10-year cardiovascular disease risk greater than 15 percent in patients older than 50 years and with a pre-treatment SBP greater than 130 mmHg)
MedicalResearch.com: What are the main findings?
Dr. Moise: We found that the JNC8 guidelines would save 43,000 annual deaths. Compared to JNC8 guidelines, JNC7 guidelines would prevent an additional 35,000 deaths. Most importantly, we found that adding lower systolic blood pressure goals to prior JNC7 and JNC8 guidelines would save costs in men and be cost-effective (or of good value) in women.
MedicalResearch.com: What should readers take away from your report?
Dr. Moise: Hypertension treatment is cheap and effective, and fear of side effects should not dissuade physicians from treating to lower goals in high-risk individuals under 75 years of age.
In addition, containing drug costs will be integral to affordable implementation of intensive blood pressure goals in this high-risk group.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Moise: Policy makers should consider risk-based hypertension treatment goals in formulating future national guidelines.
Citation:
Nathalie Moise, Chen Huang, Anthony Rodgers, Ciaran N. Kohli-Lynch, Keane Y. Tzong, Pamela G. Coxson, Kirsten Bibbins-Domingo, Lee Goldman, Andrew E. Moran. Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35–74 Years. Hypertension, 2016; HYPERTENSIONAHA.115.06814 DOI:http://dx.doi.org/10.1161/HYPERTENSIONAHA.115.06814
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on May 19, 2016 by Marie Benz MD FAAD