Using Benefit-Based Tailored Treatment to Improve the Use of Antihypertensive Medications

Study Questions:

What is the efficacy of a benefit-based tailored treatment (BTT) strategy for hypertension, as compared to a traditional treat-to-target (TTT) strategy for hypertension treatment?

Methods:

The authors developed a nationally representative sample of American adults ages 30-85 years with no history of myocardial infarction, stroke, or severe congestive heart failure, using the National Health and Nutrition Examination Survey III. They then created a simulation model to estimate the effects of 5 years of treatment with TTT (treatment to specific blood pressure goals) and BTT (treatment based on estimated cardiovascular disease [CVD] event reduction) approaches to antihypertensive medication management. All effect size estimates were directly derived from meta-analyses of randomized trials.

Results:

The investigators found that 55% of the overall population of 176 million Americans would be treated identically under the two treatment approaches. BTT would prevent 900,000 more CVD events and save 2.8 million more QALYs, despite using 6% fewer medications over 5 years. In the 45% of the population treated differently by the strategies, BTT saves 159 quality-adjusted life-years (QALYs) per 1,000 treated versus 74 QALYs per 1,000 treated by TTT. The findings were robust to sensitivity analyses.

Conclusions:

The authors concluded that BTT was both more effective and required less antihypertensive medication than current guidelines based on treating to specific blood pressure goals.

Perspective:

The study suggests that tailoring hypertension management by estimating an individual’s expected net benefit from additional blood pressure treatment (BTT) has the potential to be a more efficient and effective strategy for improving patient outcomes than current TTT guidelines. Caution is always advisable when interpreting simulation models, since a model is only as good as its inputs and assumptions, and additional research is indicated in this area. These findings do reinforce the message that clinicians should pay more attention to overall CVD risk when making blood pressure treatment decisions.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: Myocardial Infarction, Stroke, Cost-Benefit Analysis, Heart Failure, Cardiovascular Diseases, Blood Pressure, Nutrition Surveys, Pregnancy, Hypertension, Quality-Adjusted Life Years, United States


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