The benefits of normalizing blood pressure
In the 1960s. A number of randomized clinical studies have confirmed the protective effect of treating mild and moderate hypertension. An accurate assessment of the risk reduction was obtained from meta-analyzes, which showed that the reduction of DBP by 5-6 mm Hg. st. reduces the risk of cerebral stroke (MI) by 42% and the risk of coronary heart disease (CHD) by 15%.
The ALLHAT study showed the effectiveness of thiazide diuretics compared with other antihypertensive drugs (AGP). Some advantage of diuretics was a slightly better reduction in blood pressure. ALLHAT was one of 29 randomized trials included in a 2003 meta-analysis that examined the effects of various blood pressure reduction regimens on major cardiovascular events (SSSob).
There were no significant differences between treatment based on ACE inhibitors, calcium antagonists, diuretics, or β-AB, although ACE inhibitors reduced blood pressure to a lesser extent. In addition, the ego study demonstrated a linear relationship between a decrease in blood pressure and a decrease in risk. For many patients, it is necessary to prescribe 2 drugs for initial therapy, especially for patients with more severe hypertension.
The ratio of cost-effectiveness of normalization of blood pressure. Detection and control of hypertension have a high ratio of cost-effectiveness in both primary and secondary prevention. However, more “aggressive” treatment of persons at high risk due to the presence of cardiovascular disease (CVD) or diabetes mellitus (DM), based on the cost-effectiveness relationship, is warranted.
In secondary prophylaxis for drugs such as diuretics and β-AB, the cost of QALY for patients with established coronary heart disease (CHD) was <$ 10,000, even if blood pressure was increased slightly. With primary prevention, the cost of QALY varies from $ 10 thousand to $ 20 thousand among those with moderate and severe hypertension. However, for more expensive drugs, the cost is close to the unacceptable value of $ 100 thousand for QALY.
The cost-effectiveness ratio decreases with age. Given this fact, a thorough assessment of the cost-effectiveness relationship is necessary to implement the recommendations of JNC-7, since they are encouraged to use several drugs and different interventions in different groups of patients, including those with a slight increase in blood pressure.