Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) in the United States. In about 28 million adults with hypertension, blood pressure is not controlled to recommended treatment goals. Because inexpensive, safe, and effective medications are available, uncontrolled hypertension is a missed opportunity to improve the health of the U.S. population. For this project, we assembled a team of experts in hypertension, biostatistics, clinical trials, health economic evaluation, and computer simulation modeling in order to evaluate the incremental value of implementing two types of hypertension control programs studied in clinical trials: team-based care and home blood pressure monitoring. Analyses of published and individual-level clinical trial and computer simulation will be used to model, in U.S. adults ? The comparative effectiveness (number of prevented CVD events and deaths) and cost-effectiveness of different hypertension control approaches, alone or in combination, in all U.S. adults and within age categories, race/ethnic groups, and CVD risk categories ? The comparative effectiveness and cost-effectiveness different hypertension control programs in patients with uncontrolled hypertension in three Medicare Accountable Care Organizations (New York Quality Care, Ochsner Accountable Care, and Cedars-Sinai Accountable Care) ? The comparative effectiveness and cost-effectiveness of implementing a 120 mmHg systolic BP goal in high risk U.S. adults aged ?50 years according to Systolic Blood Pressure Intervention Trial (SPRINT) eligibility Relevance The results of these analyses have the potential to improve the quality of hypertension treatment in routine clinical practice, which may lead to improved cardiovascular health in the U.S. population.
Hypertension can be treated with inexpensive, safe, and effective medications, and results from recent practice-based clinical trials suggest that we can improve hypertension control with some extra effort. This research proposal aims to use detailed data from high quality practice-based clinical trials of hypertension control and computer simulation to evaluate the potential health benefits and incremental value of implementing hypertension control strategies in the U.S. population and a total population of about 3,000 Medicare patients covered by three health organizations in California, Louisiana, and New York. The project will also project the potential population health benefits of achieving lower blood pressure goals in high-risk patients with hypertension.
| Bress, Adam P; Bellows, Brandon K; King, Jordan B et al. (2017) Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control. N Engl J Med 377:745-755 |
| Zhang, Yiyi; Moran, Andrew E (2017) Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014. Hypertension 70:736-742 |
| Bress, Adam P; Kramer, Holly; Khatib, Rasha et al. (2017) Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections From NHANES (National Health and Nutrition Examination Circulation 135:1617-1628 |
