Key result
Lowering systolic blood pressure to 139 mmHg is projected to cut expected cardiovascular events by ~10%.
Why the study?
Although hypertension is amenable to treatment, only about half of Australian general practice patients achieve blood pressure control, leaving health and acute hospitalisation costs of uncontrolled hypertension unclear.
Does improved systolic blood pressure control reduce cardiovascular disease events and acute hospitalisation costs in Australian primary care patients aged 45-74 years?
Does improved systolic blood pressure control reduce cardiovascular disease events and acute hospitalisation costs in Australian primary care patients aged 45-74 years?
Improving blood pressure control in Australian primary care could prevent tens of thousands of cardiovascular events and save hundreds of millions of dollars in acute hospital costs over 5 years.
May inform Australian primary care BP targets; leaves open prospective validation before practice change.
BACKGROUND: Hypertension is the most common condition seen in Australian general practice. Despite hypertension being amenable to lifestyle modifications and pharmacological treatment, only around half of these patients have controlled blood pressure levels (< 140/90 mmHg), placing them at an increased risk of cardiovascular disease. OBJECTIVE: We aimed to estimate the health and acute hospitalisation costs of uncontrolled hypertension among patients attending general practice. METHODS: We used population data and electronic health records from 634,000 patients aged 45-74 years who regularly attended an Australian general practice between 2016 and 2018 (MedicineInsight database). An existing worksheet-based costing model was adapted to calculate the potential cost savings for acute hospitalisation of primary cardiovascular disease events by reducing the risk of a cardiovascular event over the next 5 years through improved systolic blood pressure control. The model estimated the number of expected cardiovascular disease events and associated acute hospital costs under current levels of systolic blood pressure and compared this estimate with the expected number of cardiovascular disease events and costs under different levels of systolic blood pressure control. RESULTS: The model estimated that across all Australians aged 45-74 years who visit their general practitioner (n = 8.67 million), 261,858 cardiovascular disease events can be expected over the next 5 years at current systolic blood pressure levels (mean 137.8 mmHg, standard deviation = 12.3 mmHg), with a cost of AUD$1813 million (in 2019-20). By reducing the systolic blood pressure of all patients with a systolic blood pressure greater than 139 mmHg to 139 mmHg, 25,845 cardiovascular disease events could be avoided with an associated reduction in acute hospital costs of AUD$179 million. If systolic blood pressure is lowered further to 129 mmHg for all those with systolic blood pressure greater than 129 mmHg, 56,169 cardiovascular disease events could be avoided with potential cost savings of AUD$389 million. Sensitivity analyses indicate that potential cost savings range from AUD$46 million to AUD$1406 million and AUD$117 million to AUD$2009 million for the two scenarios, respectively. Cost savings by practice range from AUD$16,479 for small practices to AUD$82,493 for large practices. CONCLUSIONS: The aggregate cost effects of poor blood pressure control in primary care are high, but cost implications at the individual practice level are modest. The potential cost savings improve the potential to design cost-effective interventions, but such interventions may be best targeted at a population level rather than at individual practices.
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Roseleur et al. (2023) studied Hypertension (n=634,000). Systolic blood pressure control to 139 mmHg vs. Current systolic blood pressure levels was evaluated on Expected cardiovascular disease events over 5 years. Lowering systolic blood pressure to 139 mmHg in Australian primary care patients with uncontrolled hypertension could avoid 25,845 cardiovascular events and save AUD$179 million over 5 years.
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