What question did this study set out to answer?

To evaluate and compare the one-year clinical outcomes and direct medical costs of four second-line antihypertensive drug regimens in managed care patients with moderate to severe hypertension.

April 1, 2002American Journal of HypertensionOpen Access

Modeling clinical and economic outcomes of antihypertensive treatment alternatives

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Why the study?

Does amlodipine/benazepril improve blood pressure control and reduce costs compared to amlodipine, felodipine, or nifedipine in patients with moderate to severe hypertension failing initial therapy?

Population

Hypothetical cohort of managed care patients with moderate to severe hypertension who had previously failed…

Comparison

Amlodipine/benazepril 2.5mg/10mg vs Amlodipine besylate 10mg, felodipine 10mg, and…

Design

Other

Follow-up

one year

Authors

SSSimon Lyck Bjært SørensenUniversity of Southern Denmark

Discussion

Member takes

Implication

May warrant preferring amlodipine/benazepril for response and cost in moderate-severe hypertension failing initial therapy; extends meta-analytic support for combinations over monotherapy.

Key Points

To evaluate and compare the one-year clinical outcomes and direct medical costs of four second-line antihypertensive drug regimens in managed care patients with moderate to severe hypertension.
Constructed a decision analysis model simulating 200,000 managed care patients with moderate to severe hypertension who failed initial diuretic or beta-blocker therapy, distributed evenly across four arms (n=50,000 per group).
Assigned patients to amlodipine besylate (10 mg), felodipine (10 mg), nifedipine (60 mg), or amlodipine/benazepril (2.5 mg/10 mg) over a one-year time horizon using efficacy and tolerability inputs from published meta-analyses and literature.
Tracked direct healthcare costs—including drug acquisition, physician visits, adverse event management, and treatment modification—supported by sensitivity analyses varying efficacy and tolerability parameters.
One-year blood pressure response rates reached 93% in the amlodipine/benazepril group, compared with 92% for felodipine, 91% for amlodipine besylate, and 88% for nifedipine.
Total annual costs were lowest for amlodipine/benazepril at $51,700,000 per 50,000 patients, compared with $58,100,000 for felodipine, $60,900,000 for nifedipine, and $60,950,000 for amlodipine besylate.
Amlodipine/benazepril retained the highest rate of patients remaining on their initial therapy without requiring dosage increases, drug switches, or add-on therapies across both baseline and sensitivity analyses.

Structured PICO

Does amlodipine/benazepril improve blood pressure control and reduce costs compared to amlodipine, felodipine, or nifedipine in patients with moderate to severe hypertension failing initial therapy?

Population

Hypothetical cohort of managed care patients with moderate to severe hypertension who had previously failed initial drug therapy (beta blockers or diuretics per JNC-VI), n=200,000.

Intervention

Amlodipine/benazepril 2.5mg/10mg

Comparator

Amlodipine besylate 10mg, felodipine 10mg, and nifedipine 60mg

Outcome

Blood pressure control and total cost of care at one yearsurrogate

In a decision analysis model, amlodipine/benazepril combination therapy was more effective and less costly than high-dose monotherapies for patients with moderate to severe hypertension failing initial treatment.

Cite This Study

Simon Lyck Bjært Sørensen (2002) studied this question.

synapsesocial.com/papers/6a709b40e5469ee92be14f38 https://doi.org/10.1016/s0895-7061(02)02412-3

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Implication

May warrant preferring amlodipine/benazepril for response and cost in moderate-severe hypertension failing initial therapy; extends meta-analytic support for combinations over monotherapy.

Modeling clinical and economic outcomes of antihypertensive treatment alternatives

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Modeling clinical and economic outcomes of antihypertensive treatment alternatives

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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