| Autor: |
Wei, Pengxiao C, Penko, Joanne, Coxson, Pamela, Bellows, Brandon, Machen, Leah, Moran, Andrew E, Bibbins-Domingo, Kirsten |
| Zdroj: |
Circulation (Ovid); March 2020, Vol. 141 Issue: Supplement 1 pAP482-AP482, 1p |
| Abstrakt: |
Introduction:The 2017 ACC/AHA guidelines redefined stage 1 hypertension to include blood pressure 130-139 mmHg/80-89 mmHg and recommended non-pharmacologic interventions (e.g., DASH diet, physical activity) for those with stage 1 hypertension and a low 10-year risk of cardiovascular disease (CVD). The cost-effectiveness of achieving target blood pressure in this low risk population in the clinical setting (via identification, diagnosis, and counseling on diet and exercise) has not been assessed.Methods:We used the Cardiovascular Disease Policy Model (CVDPM), a dynamic state-transition model of CVD in US adults to simulate achieving blood pressure control in low-risk adults aged 35-64 years with untreated stage 1 hypertension based on the 2017 ACC/AHA guidelines. Outcomes included incident CVD (coronary heart disease and stroke), CVD healthcare costs (2018 dollars), and quality-adjusted life years (QALYs) over 10 years. We projected outcomes assuming all low-risk young adults achieve control. We then varied the degree to which patients would change behaviors following diagnosis, using low uptake (20%) and high uptake (70%) estimates sourced from literature. We tested the sensitivity of health gains to decrements in QALYs associated with receiving a diagnosis using estimates from the Global Burden of Disease.Results:An estimated 7.0 million men and 6.6 million women age 35-64 years would be newly diagnosed with stage 1 hypertension and indicated for non-pharmacologic interventions according to 2017 ACC/AHA. Achieving targets of <130/80 mmHg is projected to prevent 63,200 incident CVD events and 4,800 CVD deaths and lower CVD related healthcare costs by $3.6 billion (2018 USD) over 10 years compared to no BP change. Assuming less than complete control (because of variable uptake of non-pharmacologic interventions) resulted in lower rates of CVD prevention (low uptake - 13,900 events prevented and $0.8 billion lower costs; high uptake 41,000 events prevented and $2.3 billion lower costs). In all scenarios, the magnitude of QALYs gained from preventing CVD was highly sensitive to decrements associated with anxiety from receiving a diagnosis.Conclusions:Achieving 2017 ACC/AHA stage 1 hypertension goals in newly diagnosed low-risk adults would result in substantial CVD benefit and reductions in CVD-related healthcare costs. . If these goals are to be achieved in the clinical setting, gains are likely to be offset by degree of uptake of counseling regarding non-pharmacologic interventions and anxiety related to a new diagnosis of hypertension. |
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