Intensive blood pressure control is worth extra cost, suggests study

By preventing future cardiac events, lowering systolic blood pressure to 120 mmHg in high-risk patients is cost-effective.

Intensive blood pressure control—targeting a systolic blood pressure of 120 mmHg or less versus the standard target of 140 mmHg—comes with higher up-front costs.

But a new study shows that the benefits—fewer cardiac events—outweigh those costs in the long term.

The study was published online today in the New England Journal of Medicine.

Previously, investigators from the systolic blood pressure intervention trial (SPRINT) reported in the same journal that intensive therapy lowered rates of death and cardiovascular events compared with standard treatment in 9,361 older adults (age 75 or older) with high blood pressure and other heart disease risk factors.

“An estimated 17 million older adults in the U.S. have the same risk factors as those in the SPRINT trial and stand to benefit from intensive blood pressure control,” said Andrew Moran, MD, MPH, the Herbert Irving Assistant Professor of Medicine at Columbia, a physician at NewYork-Presbyterian, and a senior author of the paper.

“But is the additional cost of intensive therapy, which may include extra trips to the doctor’s office, multiple medications, and possibly more side effects from those medications, a good value for both insurers and patients?”

To answer that question, Dr. Moran and colleagues from the SPRINT Economics Working Group used a model to simulate intensive and standard treatment in 10,000 hypothetical SPRINT-eligible patients.

The model incorporated 250 variables, including a wide range of health histories and adverse side effects, to arrive at a real-life estimate of the benefits and costs of intensive therapy.

Intensive blood pressure control was found to cost less than $50,000 for each quality-adjusted year of life gained (a commonly accepted willingness-to-pay threshold). But 10 to 20 years later, the extra expenses would be offset by the cardiac events and related treatment costs prevented by intensive treatment.

A second study, led by researchers at the Rogers Memorial Veterans Hospital in Bedford, Mass., and published in the same issue of the journal, showed that SPRINT participants on intensive therapy were as satisfied with their care as those on standard therapy despite the additional medications and doctor visits.

“Intensive blood pressure treatment prevents heart disease, but it requires extra effort from patients and health care providers,” said Dr. Moran.

“Our study showed that it is a very good value if the treatment is sustained long term. These findings, in combination with the evidence that adhering to multiple antihypertensive medications does not affect health-related quality of life, suggest that the intensive treatment approach could be used more widely in patients at high risk for heart disease.”