Kim Stitzel, M.S., R.D., Senior Vice President, Center for Health Metrics and Evaluation
Emily A. Callahan, M.P.H., R.D.N., Owner, EAC Health and Nutrition, LLC
Gradual implementation of the 2017 high blood pressure treatment guidelines developed by the American College of Cardiology and the American Heart Association is expected to be cost-effective, according to preliminary research to be presented Nov. 17 at the Association’s annual Scientific Sessions meeting in Philadelphia. Scientific Sessions is the premier annual global exchange of the latest advances in cardiovascular science for researchers and clinicians.
Researchers evaluated the cost-effectiveness of incrementally implementing treatment according to the 2017 ACC/AHA guidelines compared to the 2003 Joint National Committee on Hypertension guidelines, in currently untreated U.S. adults (ages 35-84) with hypertension. The 2017 guidelines lowered blood pressure targets and significantly expanded the number of U.S. adults eligible for treatment, compared with prior guidelines.
Cost-effectiveness was assessed based on first treating the high blood pressure patients who were at highest risk for CVD, then adding progressively lower-risk patients until reaching the entire population indicated for treatment according to the 2017 guidelines.
Based on a simulated implementation period of 2018-2027, the 2017 guidelines would treat 5.2 million more patients, intensify treatment in another 11.7 million patients and prevent about 257,000 CVD events over 10 years.
Incremental cost-effectiveness ratios (ICERs) for applying the 2017 guidelines to only CVD patients would range from approximately $25,000/quality-adjusted life year (QALY) gained in the oldest men to $900,000/QALY in the youngest women. When adding patients without CVD, uncontrolled high blood pressure or increased 10-year CVD risk, ICERs ranged from around $50,000/QALY among the oldest/high-risk patients to possible harm among the youngest/low-risk patients.
Lowering blood pressure lengthens life expectancy
A key source of evidence supporting the 2017 ACC/AHA guidelines is the Systolic Blood Pressure Intervention Trial, or SPRINT, which showed that intensive blood pressure control (systolic BP target <120 mmHg) was superior to standard blood pressure control (systolic BP target <140 mmHg) for reducing cardiovascular events and mortality among middle-aged and older nondiabetic adults at high risk for CVD.
In a follow-up analysis of SPRINT data, also to be presented at the Association’s Scientific Sessions on Nov. 17, researchers estimated that intensive blood pressure control improved patients’ residual survival by six months to three years, compared with standard control. For example, at age 50, estimated residual survival was 37.3 years with intensive blood pressure control treatment and 34.4 years with standard treatment. The absolute survival gains with intensive treatment decreased with age, but the relative gains were consistent (4% to 9%) across age groups.
Making the expected gains a reality
Achieving the improvements forecast by these two preliminary studies will require enhancements in the prevention, detection, evaluation and management of high blood pressure. But the job isn’t done once blood pressure is in a healthy zone – keeping it there requires close monitoring and regular communication between patients and health care providers. Programs that integrate community and clinical health resources and leverage technology platforms have shown promise in improving blood pressure control, and they should be replicated so more communities can benefit.
The systems-wide changes that will facilitate implementation of the 2017 ACC/AHA guidelines will require substantial resources, but the expected improvement in health outcomes and the net cost-effectiveness of implementing the guidelines are compelling reasons to stay the course.
- Blood Pressure Status of US Adults: NHANES 1999-2016 (interactive data visualization)
- Trends in Prevalence of Hypertension Awareness, Treatment, and Control in US Adults: NHANES 2001-2016 (interactive data visualization)