New Blood Pressure Guidelines Could Save Lives and Money

By Sondra Forsyth

Adhering to new hypertension guidelines could prevent thousands of heart attacks and deaths each year – without increasing health care costs, according to researchers.

The investigators, from Columbia University Medical Center (CUMC), published their findings in 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,” said lead author Andrew E. Moran, MD, MPH, the Herbert Irving Assistant Professor of Medicine at CUMC and a physician at NewYork-Presbyterian/Columbia. “In fact, we could double treatment and monitoring spending for some patients—namely those with severe hypertension—and still break even.”

New guidelines for treatment of high blood pressure, released earlier this year, emphasized a shift to targeting people with higher blood pressure. But, Moran said, “even with the more relaxed goals, an estimated 44 percent of adults with hypertension, or 28 million people, still do not have their blood pressure adequately controlled.”

The researchers ran a computer simulation for U.S. adults age 35 to 74 from 2014 to 2024, taking into account the impact and cost-effectiveness of the new guidelines.

They concluded that implementation of the guidelines would save costs by reducing deaths related to cardiovascular disease (CVD). The cost savings were realized, the investigators said, by employing secondary prevention (post-diagnosis care) in patients with CVD and primary prevention in people with stage 2, or severe, hypertension.  Treating stage 1 hypertension was cost effective in all men and women age 45 to 74.

Ultimately, they concluded that the new guidelines could prevent 56,000 CVD events (mostly heart attacks and strokes) and 13,000 deaths each year.

However, the investigators also found that treating women ages 35 to 44 with stage 1 hypertension and without CVD had intermediate- or low-value cost-effectiveness. “Some people will be alarmed about our conclusion that it may not be cost-effective to treat hypertension in young adults, especially young women,” said Dr. Moran. “It’s worth noting that our analysis didn’t capture the cumulative, lifetime effects of hypertension. It may well turn out to be cost-effective to treat this group if we look at data on costs and benefits over several decades. This warrants further study.”

Stage 1 hypertension is defined as a systolic BP of 140–159 mm Hg or a diastolic BP of 90–99 mm Hg. Stage 2, or severe, hypertension is a systolic BP of 160 mmHg or higher or a diastolic BP of 100 mmHg or higher.