There are presently >65 million adults with hypertension in the United States.4 As the population ages, the prevalence of hypertension continues to increase. The health care costs due to hypertension are estimated at $76.6 million in 20104 and approximately 395,000 deaths, or one in six deaths were attributed to elevated blood pressure in 2005.3 Traditionally, U.S. blood pressure guidelines have based treatment recommendations on blood pressure levels and targets-a """"""""treat-to-target"""""""" approach. Alternative approaches base treatment recommendations on short- or long-term risk for cardiovascular events, predicted using age, sex, blood pressure, and other major risk factors to estimate risk-a risk-based or """"""""tailored"""""""" approach. Important demographic changes in the U.S. population have the potential to impact the relative cost effectiveness of these strategies. These demographic changes include aging of the population, growth of the proportion of African Americans and Hispanic Americans in the population, and increases in the prevalence of overweight and obesity. No formal clinical effectiveness analysis or cost-effectiveness analysis comparing these two approaches to blood pressure treatment has been published for the U.S., though such analyses have recently been published for other countries. Further, comparative analyses of these strategies in demographic groups defined by age, sex, race/ethnicity and obesity status have not been published. Such analyses have the potential to inform treatment recommendations in important ways. The Coronary Heart Disease (CHD) Policy Model is an epidemiologic and comparative effectiveness computer model of cardiovascular disease in U.S. adults. Using a version of the CHD Policy Model adapted and validated to predict stroke, heart failure and end-stage renal disease as well as CHD, we propose to: Compare """"""""treat-to-target"""""""" guidelines to """"""""tailored"""""""" guidelines based on patients'predicted medium term (10-year) and long term (30-year) risk for cardiovascular events;Assess the impact of both """"""""treat-to-target"""""""" and """"""""tailored"""""""" guidelines in U.S. adults during the years 2010-2030 in the context of 1) the aging of the population, 2) the relatively faster growth of African American and Mexican American populations (populations with higher hypertension prevalence and lower blood pressure treatment rates, respectively) and 3) various obesity and overweight trend scenarios. The results of these analyses have the potential to help better define the optimal blood pressure control guidelines for the U.S. and identify population subgroups that may benefit most from complete implementation of guidelines. An optimally designed national BP control program has the potential to greatly alleviate the burden of BP-related morbidity and mortality while saving tens of millions of health care dollars annually in coming decades.

Public Health Relevance

Approximately 65 million U.S. adults have high blood pressure, and more of cardiovascular disease mortality is attributed to high blood pressure than to any other single risk factor. National guidelines define standards for high blood pressure diagnosis and treatment, and guidelines determine the health impact of U.S. blood pressure control policy. Using a computer model of the effects of high blood pressure on cardiovascular disease and end-stage kidney disease in U.S. adults, we propose to compare the effectiveness of treat-to-target and tailored, risk-based blood pressure guidelines, and forecast the impact of blood pressure control guidelines over future years in the context of demographic and body weight changes. The results of these analyses have the potential to help to better define the optimal blood pressure control guidelines for the U.S. and identify population subgroups that may benefit most from complete implementation of guidelines. An optimally designed national blood pressure control program has the potential to greatly alleviate the burden of blood pressure-related morbidity and mortality and save tens of millions of health care dollars annually in coming decades.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL107475-03
Application #
8508298
Study Section
Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Einhorn, Paula
Project Start
2011-08-19
Project End
2014-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
3
Fiscal Year
2013
Total Cost
$410,697
Indirect Cost
$119,060
Name
Columbia University (N.Y.)
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Odden, Michelle C; Moran, Andrew E; Coxson, Pamela G et al. (2016) Gait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study. J Am Geriatr Soc 64:1015-23
Moise, Nathalie; Huang, Chen; Rodgers, Anthony et al. (2016) Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model. Hypertension 68:88-96
Vasudeva, Eshan; Moise, Nathalie; Huang, Chen et al. (2016) Comparative Cost-Effectiveness of Hypertension Treatment in Non-Hispanic Blacks and Whites According to 2014 Guidelines: A Modeling Study. Am J Hypertens 29:1195-205
Pletcher, Mark J; Vittinghoff, Eric; Thanataveerat, Anusorn et al. (2016) Young Adult Exposure to Cardiovascular Risk Factors and Risk of Events Later in Life: The Framingham Offspring Study. PLoS One 11:e0154288
Gu, Dongfeng; He, Jiang; Coxson, Pamela G et al. (2015) The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study. PLoS Med 12:e1001860
Moran, Andrew E; Odden, Michelle C; Thanataveerat, Anusorn et al. (2015) Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med 372:447-55
Odden, Michelle C; Coxson, Pamela G; Moran, Andrew et al. (2011) The impact of the aging population on coronary heart disease in the United States. Am J Med 124:827-33.e5