Affiliation:
1. Department of Medicine Columbia University New York NY USA
2. Department of Medicine Mount Sinai New York NY USA
3. Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Philadelphia PA USA
4. Intermountain Healthcare Department of Population Health Sciences University of Utah Salt Lake City UT USA
5. Nuffield Department of Primary Care Health Sciences University of Oxford UK
6. Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
7. Department of Medicine Georgetown University Washington DC USA
8. MedStar Health Research Institute Washington DC USA
Abstract
Background
Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long‐term impact of 4 hypertension management strategies in SPRINT‐eligible US adults.
Methods and Results
The validated Blood Pressure Control–Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT‐eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP <140/90 mm Hg (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care), (2) intensive care per the SPRINT protocol targeting BP <120/90 mm Hg (SPRINT intensive), (3) usual care targeting guideline‐recommended BP <130/80 mm Hg (American College of Cardiology/American Heart Association usual care), and (4) team‐based care added to usual care and targeting BP <130/80 mm Hg. Relative to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, among the 18.1 million SPRINT‐eligible US adults, an estimated 138 100 total CVD events could be prevented per year with SPRINT intensive, 33 900 with American College of Cardiology/American Heart Association usual care, and 89 100 with team‐based care. Compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, SPRINT intensive care was projected to increase treatment‐related serious adverse events by 77 600 per year, American College of Cardiology/American Heart Association usual care by 33 300, and team‐based care by 27 200.
Conclusions
As BP control has declined in recent years, health systems must prioritize hypertension management and invest in effective strategies. Adding team‐based care to usual care may be a pragmatic way to manage risk in this high‐CVD‐risk population.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine