Key result
Intensive systolic blood pressure treatment (target <120 mm Hg) in eligible Chinese adults was projected to increase mean QALYs by 0.38 at an incremental cost of Int$10,997 per QALY gained.
Why the study?
SPRINT demonstrated reductions in death and CVD risk with an SBP goal of <120 mm Hg, but its applicability and economic implications in Chinese adults were unknown.
Does intensive blood pressure treatment (SBP <120 mm Hg) improve clinical outcomes and is it cost-effective compared to standard treatment (SBP <140 mm Hg) in Chinese adults meeting SPRINT eligibility criteria?
Does intensive blood pressure treatment (SBP <120 mm Hg) improve clinical outcomes and is it cost-effective compared to standard treatment (SBP <140 mm Hg) in Chinese adults meeting SPRINT eligibility criteria?
Adopting the SPRINT intensive blood pressure target (<120 mm Hg) in eligible Chinese adults has the potential to prevent millions of cardiovascular deaths and is likely cost-effective over a lifetime.
Answers are grounded in this paper and cite their sources.
May support intensive BP targets in eligible Chinese adults; extends SPRINT modeling to Asia but leaves open prospective validation.
BACKGROUND: The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of <120 mm Hg compared with a SBP goal of <140 mm Hg. Our study aimed to assess the applicability of SPRINT to Chinese adults. Additionally, we sought to predict the medical and economic implications of this intensive SBP treatment among those meeting SPRINT eligibility. METHODS AND FINDINGS: We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI -0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI -0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130-139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease. CONCLUSIONS: Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.
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Li et al. (2021) studied Hypertension and high cardiovascular risk (n=10,000). Intensive systolic blood pressure treatment (SBP goal <120 mm Hg) vs. Standard treatment (SBP goal <140 mm Hg) was evaluated on Quality-adjusted life-years (QALYs) (MD 0.38, 95% CI 0.13-0.71). Intensive systolic blood pressure treatment (target <120 mm Hg) in eligible Chinese adults was projected to increase mean QALYs by 0.38 at an incremental cost of Int$10,997 per QALY gained.
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