Key result
Increasing the systolic blood pressure control rate to 40% in the Russian hypertensive population was simulated to reduce major adverse cardiac events by 12.9% compared to current care over 10 years.
Why the study?
Does increasing systolic blood pressure control (with or without lipid control and smoking cessation) reduce cardiovascular events and mortality in the Russian hypertensive population?
Does increasing systolic blood pressure control (with or without lipid control and smoking cessation) reduce cardiovascular events and mortality in the Russian hypertensive population?
Effect estimate: RRR 12.9% (95% CI 11.6-14.2)
Absolute Event Rate: 0.256% vs 0.294%
Improving systolic blood pressure control to 40% or 60% in the Russian hypertensive population could prevent millions of cardiovascular deaths and save billions in direct healthcare costs over 10 years.
May inform Russian hypertension policy; extends modeling data but leaves open prospective validation.
OBJECTIVES: Russia faces a high burden of cardiovascular disease. Prevalence of all cardiovascular risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment programs aimed at increasing blood pressure control would affect cardiovascular outcomes. In addition, we investigated what additional benefit adding lipid control and smoking cessation to blood pressure control would generate in terms of reduced cardiovascular events. Finally, we estimated the direct health care costs saved by treating fewer cardiovascular events. METHODS: The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure <140 mmHg) of 40% and 60% were simulated by modifying adherence rates of an antihypertensive medication combination and compared with current care (23.9% blood pressure control rate). Outcomes of major adverse cardiovascular events; cerebrovascular event (stroke), myocardial infarction, and cardiovascular death over a 10-year time horizon were reported. Direct health care costs of strokes and myocardial infarctions were derived from official Russian statistics and tariff lists. RESULTS: To achieve systolic blood pressure control rates of 40% and 60%, adherence rates to the antihypertensive treatment program were 29.4% and 65.9%. Cardiovascular death relative risk reductions were 13.2%, and 29.6%, respectively. For the current estimated 43,855,000-person Russian hypertensive population, each control-rate scenario resulted in an absolute reduction of 1.0 million and 2.4 million cardiovascular deaths, and a reduction of 1.2 million and 2.7 million stroke/myocardial infarction diagnoses, respectively. Averted direct costs from current care levels ($7.6 billion [in United States dollars]) were $1.1 billion and $2.6 billion, respectively.
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Shum et al. (2014) studied Hypertension (n=100,000). Antihypertensive combination pill (ARB, CCB, and diuretic) to achieve 40% SBP control vs. Current care (23.9% SBP control) was evaluated on Major adverse cardiac event (MACE) (RRR 12.9%, 95% CI 11.6-14.2). Increasing the systolic blood pressure control rate to 40% in the Russian hypertensive population was simulated to reduce major adverse cardiac events by 12.9% compared to current care over 10 years.
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