Hypertension (HTN), which affects nearly 80 million U.S. adults and costs society approximately $80 billion annually, is the leading modifiable cause of cardiovascular disease (CVD). Current guidelines recommend a standard systolic blood pressure (SBP) treatment goal of <140 mmHg in most patients. The Systolic Blood Pressure Intervention Trial (SPRINT) showed a 25% reduction in CVD events with intensive SBP treatment (<120 mmHg) in high CVD risk adults. However, intensive SBP treatment likely requires additional health care resources and practice changes so it will be challenging to implement in real-world settings. This project proposes to: (1) build and validate a ?hybrid? hypertension treatment simulation model to determine the cost-effectiveness of intensive SBP treatment in a population-based sample of SPRINT-eligible U.S. adults, (2) incorporate local data from diverse health systems into the hybrid blood pressure model to compare the cost-effectiveness of intensive SBP treatment implementation strategies, (3) engage local stakeholders in study design and communication strategies, and (4) disseminate results to local and national stakeholders to optimize intensive SBP treatment implementation. The central hypothesis is that intensive SBP treatment implementation in health systems will be feasible and cost-effective in high CVD risk patients compared to standard treatment even when considering local implementation factors. Most past research using computer simulation methods generates ?average? national population estimates and the models are often considered opaque ?black boxes? by decision makers. This project is innovative as it applies simulation methods to the local health system level, using local patient data, and engages local stakeholders to address practical implementation barriers and facilitators. For intensive SBP treatment, this may result in more efficient and safer implementation, while also reducing the burden of CVD attributed to raised SBP. My career goal is to become a principal investigator and expert focused on the use of computer simulations to improve healthcare delivery, quality, and population health. The proposed career development plan will provide training and mentorship in: (1) advanced computer simulation methods; (2) analysis of individual-level data from clinical trials, observational cohorts, national surveys, and health systems; (3) qualitative methods; and (4) dissemination and communication of computer simulation research results. This training will be achieved through coursework, hands-on experience, and active mentoring. The mentoring team is comprised of nationally recognized experts in hypertension, clinical trials, computer simulation, cost-effectiveness analysis, epidemiology, qualitative methods, and dissemination.!The University of Utah provides an ideal research environment for my transition to independence.
/RELEVANCE TO PUBLIC HEALTH Nearly 17 million U.S. adults with hypertension meet the eligibility criteria for the Systolic Blood Pressure Intervention Trial, which showed a 25% reduction in cardiovascular disease events with intensive compared to standard systolic blood pressure treatment. The objective of this project is to use computer simulations to compare the feasibility and cost-effectiveness of implementing intensive systolic blood pressure treatment in the national population and at the local level in four distinct health systems. This project will develop an approach to integrating computer simulations into the process of designing and evaluating intensive blood pressure treatment, which may result in more efficient and safer implementation and reduce the burden of cardiovascular disease attributed to hypertension.