Effectiveness of Hypertension Management Strategies in SPRINT‐Eligible US Adults: A Simulation Study

Figure 1. Hypertension management strategies and effects on care processes. *JNC 7 BP goal was <140/90 mm Hg for most patients and <130/80 mm Hg for patients with chronic kidney disease or diabetes if developed during the simulation. **Physician visits during the intervention period for SPRINT were according to the SPRINT protocol, that is, once per month for 3 months, then once every 3 months. For usual care, physician visits were dependent on BP control at the visit and other patient and visit characteristics (Data S3 and Table S3). During the postintervention period, increased or decreased physician visit frequency vs usual care were a result of BP control achieved during the intervention period. ***BP measurement accuracy was dependent on the number of BP readings per visit and total number of visits. In the postintervention period, increased BP measurement accuracy vs usual care was a result of a higher total number of visits. The figure shows the 4 hypertensive management strategies simulated, including the targeted BP goal, duration of the interventions, and relative effect on hypertension care processes vs usual care. ++ and + indicate strong and moderate effects, respectively,…

Figure 2. Projected mean systolic blood pressured achieved. The figure shows the projected mean SBP achieved each year over 10 years with each hypertension management strategy in a population weighted to resemble SPRINT. The results are presented as the mean and 95% uncertainty interval (gray shaded regions) calculated by running 200 probabilistic iterations in which the model was run repeatedly when randomly sampling input parameters from prespecified statistical distributions. ACC indicates American College of Cardiology; AHA, American Heart Association; JNC 7, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; SBP, systolic blood pressure; SPRINT, Systolic Blood Pressure Intervention Trial; and TBC, team‐based care.

Figure 3. Estimated survival and healthy life years in US adults meeting SPRINT eligibility criteria. The figure shows the mean survival from baseline with each hypertension management strategy in a population weighted to all 18.1 million SPRINT‐eligible US adults. The results are presented as the mean and 95% uncertainty interval (error bar) calculated by running 200 probabilistic iterations in which the model was run repeatedly when randomly sampling input parameters from prespecified statistical distributions. The solid region indicates the healthy life years, which adjusted survival for acute CVD events, chronic CVD, intolerable adverse events, SAEs, hypertension, dyslipidemia, obesity, diabetes, end‐stage renal disease, and other comorbidities with aging. ACC indicates American College of Cardiology; AHA, American Heart Association; CVD, cardiovascular disease; JNC 7, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; SAE, serious adverse event; and SPRINT, Systolic Blood Pressure Intervention Trial.