BACKGROUND:
Hypertension is among the most common
chronic condition in middle-aged and older adults. Approximately 50 million Americans are currently diagnosed with this condition, and more than $18.7 billion is spent on
hypertension management, including $3.8 billion for medications. There are numerous pharmacological agents that can be chosen to treat
hypertension by physicians in clinical practices. The purpose of this study was to assess the cost of alternative
antihypertensive treatments in older adults with
isolated systolic hypertension (ISH). METHOD: Using the
Systolic Hypertension in the Elderly Program (SHEP) and other data, a cost-minimization analysis was performed. The cost was presented as the cost of number-needed-to treat (NNT) of patients for 5 years to prevent one adverse event associated with
cardiovascular disease (CVD). RESULT: It was found that the cost of 5 year NNT to prevent one adverse CVD event ranged widely from $6,843 to $37,408 in older patients with ISH. The incremental cost of the 5 year NNT was lower to treat older patients in the very high CVD risk group relative to patients in the lower CVD risk group, ranging from $456 to $15,511. Compared to the cost of the 5 year NNT of other commonly prescribed
antihypertensive drugs, the cost of SHEP-based
therapy is the lowest. The incremental costs of the 5 year NNT would be higher if other agents were used, ranging from $6,372 to $38,667 to prevent one CVD event relative to SHEP-based
drug therapy. CONCLUSION:
Antihypertensive therapy that is
diuretic-based and that includes either low-dose
reserpine or
atenolol is an effective and relatively inexpensive strategy to prevent cardiovascular events in older adults with
isolated systolic hypertension. Use of the
diuretic-based
therapy is the most cost-effective in patients at high risk for developing
cardiovascular disease.