Skip to main content
SpringerLink
Log in

Economic Factors in the Initiation of Antihypertensive Therapy

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Optimal management of hypertension involves finding a balance among its benefits, risks and costs. Cost-effectiveness analysis helps to clarify not only the trade-offs between the costs and benefits of treatment, but also the trade-offs between the risks and benefits, and the costs and quality of therapy. Existing analyses of hypertension treatment suggest a consistent set of strategies by which cost-effectiveness may be improved. These include strategies to increase the effectiveness of therapy, such as excluding false-positive diagnoses of hypertension, and according higher priority to treating patients with sustained elevations of diastolic blood pressure above 100mm Hg. A complementary set of strategies involve reducing the costs of therapy by prescribing lower-cost first-step regimens, making use of the minimum effective dose for particular medicines and attempting step-down therapy for suitable patients. Consideration of economic factors in initiating hypertension treatment is consistent with sound clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alderman MH. Which antihypertensive drugs first — and why! Journal of the American Medical Association 267: 2786–2787, 1992

    Article  PubMed  CAS  Google Scholar 

  • American College of Physicians, Health and Public Policy Committee. Automated ambulatory blood pressure monitoring. Annals of Internal Medicine 104: 275–278, 1986

    Google Scholar 

  • Baksaas I. Patterns in drug utilization — national and international aspects: antihypertensive drugs. Acta Medica Scandinavica 683 (Suppl): 59–66, 1984

    PubMed  CAS  Google Scholar 

  • Beaglehole R, Bonita R, Jackson R, Stewart A. Prevention and control of hypertension in New Zealand: a reappraisal. New Zealand Medical Journal 101: 480–483, 1988

    PubMed  CAS  Google Scholar 

  • Bergman U. Antihypertensives in Sweden — sales and therapeutic traditions. In Strandberg et al. (Eds) Treatment of mild hypertension. National Board of Health and Welfare Drug Information Committee, Uppsala, Sweden, 1987

    Google Scholar 

  • Blaufox MD, Langford HG, Oberman A, Hawkins CM, Wassertheil-Smoller S, et al. Effect of dietary change on the return of hypertension after withdrawal of prolonged antihypertensive therapy (DISH). Journal of Hypertension 2 (Suppl. 3): 179–181, 1984

    Google Scholar 

  • Bock KD. Changing prescription patterns: impact on costs. Journal of Hypertension 5 (Suppl. 3): S83–S85, 1987

    PubMed  CAS  Google Scholar 

  • Bostick Rm, Luepker RV, Kofron PM, Pirie PL. Changes in physician practice for the prevention of cardiovascular disease. Archives of Internal Medicine 151: 478–484, 1991

    Article  PubMed  CAS  Google Scholar 

  • British Hypertension Working Party. Treating mild hypertension: agreement from large trials. British Medical Journal 298: 694–698, 1989

    Article  Google Scholar 

  • Carlsen JE, Kober L, Torp-Pedersen C, Johansen P. Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. British Medical Journal 300: 975–978, 1990

    Article  PubMed  CAS  Google Scholar 

  • Croog SH, Levine S, Testa MA, Brown B, Bulpitt CJ et al. The effects of antihypertensive therapy on the quality of life. New England Journal of Medicine 314: 1657–1664, 1986

    Article  PubMed  CAS  Google Scholar 

  • Cutler JA, Brittain E. Calcium and blood pressure. An epidemiological perspective. American Journal of Hypertension 3: 137S, 1990

    PubMed  CAS  Google Scholar 

  • Douglas-Jones AP, Cruickshank JM. Once-daily dosing with atenolol in patients with mild or moderate hypertension. British Medical Journal 1: 990–991, 1976

    Article  PubMed  CAS  Google Scholar 

  • Edelson JT, Weinstein MC, Tosteson ANA, Williams L, Lee TH, et al. Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension. Journal of the American Medical Association 263: 408–413, 1990

    Article  Google Scholar 

  • Evans CE, Haynes RB, Goldsmith CH, Hewson SA. Home blood-pressure measuring devices: a comparative study of accuracy. Journal of Hypertension 7: 133–142, 1989

    Article  PubMed  CAS  Google Scholar 

  • Forrow L, Wartman SA, Brock DW. Science, ethics, and the making of clinical decisions. Implications for risk factor intervention. Journal of the American Medical Association 259: 3161–3167, 1988

    Article  PubMed  CAS  Google Scholar 

  • Gifford RW. Essential hypertension: cost-effective evaluation and treatment. American Journal of Medicine 81 (Suppl C): C–23–C–37, 1986

    Google Scholar 

  • Gifford RW, Borazanian RA. Traditional first-line therapy. Overview of medical benefits and side effects. Hypertension 13 (Suppl. 1): I–119–I–124, 1989

    Google Scholar 

  • Hampton JR. Evidence suggesting that mild hypertension need not be treated. Journal of Hypertension 4 (Suppl. 5): S528–S532, 1986

    PubMed  CAS  Google Scholar 

  • Herxheimer A. How much drug in the tablet? Lancet 337: 346–348, 1991

    Article  PubMed  CAS  Google Scholar 

  • Hjort PF, Holmen J, Waaler HT. Relation between drug utilization and morbidity pattern: antihypertensive drugs. Acta Medica Scandinavica (Suppl. 683): 89–93, 1984

    Google Scholar 

  • Hurley SF, Williams SL, McNeil JJ. Trends in prescribing of antihypertensive drugs in Australia, 1977–1987. Medical Journal of Australia 152: 259–266, 1990

    PubMed  CAS  Google Scholar 

  • Jeffers TA, Webster J, Petrie JC, Barker NP. Atenolol once-daily in hypertension. British Journal of Clinical Pharmacology 4: 523–527, 1977

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Jönsson B. Cost-effectiveness analysis of hypertension treatment: a review of methodological issues. Health Policy 19: 55–78, 1991

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Jönsson B. A review of cost-effectiveness analyses of hypertension. PharmacoEconomics 1: 250–264, 1992

    Article  PubMed  CAS  Google Scholar 

  • Johannesson M, Borgquist L, Jönsson B, Rastam L. The costs of treating hypertension: an analysis of different cut-off points. Health Policy 18: 141–150, 1991

    Article  PubMed  CAS  Google Scholar 

  • Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Archives of Internal Medicine 148: 1023–1038, 1988

    Article  Google Scholar 

  • Kaplan NM, Alderman MH, Flamenbaum W, McCarron DA, Perry HM, Saunders E, Schoenberger JA. Guidelines for the treatment of hypertension. American Journal of Hypertension 2: 75–77, 1989

    PubMed  CAS  Google Scholar 

  • Kaplan NM. Long-term effectiveness of nonpharmacological treatment of hypertension. Hypertension 18 (Suppl. 3): 1–153, 1991

    Google Scholar 

  • Kaplan NM. The appropriate goals of antihypertensive therapy: neither too much nor too little. Annals of Internal Medicine 116: 686–690, 1992

    PubMed  CAS  Google Scholar 

  • Kawachi I, Malcolm LA, Purdie G. Variability in antihypertensive drug therapy in general practice: results from a random national survey. New Zealand Medical Journal 102: 307–309, 1989

    PubMed  CAS  Google Scholar 

  • Kawachi I, Malcolm LA. The benefits of treating mild to moderate hypertension. A quantitative estimation of the life expectancy gains from pharmacological reduction of blood pressure. Journal of Clinical Epidemiology 42: 905–912, 1989a

    Article  PubMed  CAS  Google Scholar 

  • Kawachi I, Malcolm LA. The rising expenditure on antihypertensive drugs in New Zealand, 1981–1987. Health Policy 12: 275–284, 1989b

    Article  PubMed  CAS  Google Scholar 

  • Kawachi I, Malcolm LA. Treating mild to moderate hypertension: cost-effectiveness and policy implications. Journal of Cardiovascular Pharmacology 16 (Suppl. 7): S126–S128, 1990

    PubMed  Google Scholar 

  • Kawachi I, Malcolm LA. The cost-effectiveness of treating mild-to-moderate hypertension: a reappraisal. Journal of Hypertension 9: 199–208, 1991

    Article  PubMed  CAS  Google Scholar 

  • Knorr M, Freilingsdorf J, Graf F, Vetter H, Vetter W. Prescription patterns and costs of antihypertensive drugs in two outpatient clinics: Zurich (Switzerland) and Munster (FRG), 1975–1985. Nephron 47 (Suppl. 1): 120–124, 1987

    Article  PubMed  Google Scholar 

  • Langford HG, Balufox MD, Oberman A, Hawkins M, Curb JD et al. Dietary therapy slows the return of hypertension after stopping prolonged medication. Journal of the American Medical Association 253: 657–664, 1985

    Article  PubMed  CAS  Google Scholar 

  • Littenberg B, Garber AM, Sox HC Jr. Screening for hypertension. Annals of Internal Medicine 112: 192–202, 1990

    PubMed  CAS  Google Scholar 

  • McCarron DA, Hare LE, Walker BR. Therapeutic and economic controversies in antihypertensive therapy. Journal of Cardiovascular Pharmacology 6: S837–840, 1984

    Article  PubMed  Google Scholar 

  • Maling TJB, Kawachi I. Minimum effective dosage in the drug treatment of hypertension: a cost effective strategy for prescribers. New Zealand Medical Journal 103: 231–233, 1990

    PubMed  CAS  Google Scholar 

  • MacMahon SW, Cutler JA, Furberg CD, Payne GH. The effects of drug treatment for hypertension on morbidity and mortality from cardiovascular disease: a review of randomised controlled trials. Progress in Cardiovascular Disease 39: 99–118, 1986

    Article  Google Scholar 

  • MacMahon S, Peto R, Cutler J, Collins R, Sorlie P et al. Blood pressure, stroke, and coronary heart disease. Part 1: Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 765–774, 1990

    Article  PubMed  CAS  Google Scholar 

  • Management Committee of the Australian Therapeutic Trial in Mild Hypertension. Untreated mild hypertension. Lancet 1: 185–191, 1982

    Google Scholar 

  • McVeigh G, Galloway D, Johnston D. The case for low dose diuretics in hypertension: comparison of low and conventional doses of cyclopenthiazide. British Medical Journal 297: 95–98, 1988

    Article  PubMed  CAS  Google Scholar 

  • Memorandum from a WHO/ISH Meeting. 1989 guidelines for the management of mild hypertension. Journal of Hypertension 7: 689–693, 1989

    Google Scholar 

  • Millar JA, Waal-Manning HJ. Current treatment of hypertension. Part 1: diagnosis and nonpharmacological therapy. New Zealand Medical Journal 105: 39–40, 1992a

    PubMed  CAS  Google Scholar 

  • Millar JA, Waal-Manning HJ. Current treatment of hypertension. Part 2: risk factors, drug treatment and economic aspects. New Zealand Medical Journal 105: 61–63, 1992b

    PubMed  CAS  Google Scholar 

  • Millar JA. Unit tablet size of antihypertensive drugs. New Zealand Medical Journal 105: 65, 1992

    PubMed  CAS  Google Scholar 

  • Moser M. Is drug treatment indicated for mild hypertension with diastolic blood pressure 90mm Hg to 100mm Hg? An affirmative view. Journal of Family Practice 26: 449–459, 1988

    PubMed  CAS  Google Scholar 

  • Oberman A, Wassertheil-Smoller S, Langford HG, Blaufox MD, Davis BR, et al. Pharmacologic and nutritional treatment of mild hypertension: changes in cardiovascular risk status. Annals of Internal Medicine 112: 89, 1990

    PubMed  CAS  Google Scholar 

  • Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, et al. How common is white coat hypertension? Journal of the American Medical Association 259: 225–228, 1988

    Article  PubMed  CAS  Google Scholar 

  • Ray WA, Schaffner W, Oates JA. Therapeutic choice in the treatment of hypertension. American Journal of Medicine 81 (Suppl. 6c): 9–16, 1986

    Article  PubMed  CAS  Google Scholar 

  • Reeves RA, Myers MG. Introduction: Ambulatory blood pressure monitoring — an emerging technology. Clinical and Investigative Medicine 14: 198–201, 1991

    PubMed  CAS  Google Scholar 

  • Schmieder RE, Rockstroh JK, Messerli FH. Antihypertensive therapy. To stop or not to stop? Journal of the American Medical Association 265: 1566–1571, 1991

    Article  PubMed  CAS  Google Scholar 

  • Serlin MJ, Orme MLE, Baber NS, Sibeon RG, Breckenridge A. Propranolol in the control of blood pressure: a dose response study. Clinical Pharmacology and Therapeutics 127: 586–592, 1980

    Google Scholar 

  • SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final Results of the Systolic Hypertension in the Elderly Program. Journal of the American Medical Association 265: 3255–3264, 1991

    Article  Google Scholar 

  • Sleight P. High blood pressure. What level to treat? Journal of Cardiovascular Pharmacology 7: S109–S111, 1985

    Article  PubMed  Google Scholar 

  • Stason WB. Cost and quality trade-offs in the treatment of hypertension. Hypertension 13 (Suppl. I): I–145–I–148, 1989

    Google Scholar 

  • Steven ID, Wilson DH, Wakefield MA, Beilby J, Coffey GA, et al. South Australian hypertension survey. General practitioner knowledge and reported management practices — a cause for concern? Medical Journal of Australia 156: 423–428, 1992a

    PubMed  CAS  Google Scholar 

  • Steven ID, Wilson DH, Wakefield MA, Beilby J, Coffey GA, et al. South Australian hypertension survey. General practitioner experiences with drug treatment. Medical Journal of Australia 156: 641–644, 1992b

    PubMed  CAS  Google Scholar 

  • Swales JD. First line treatment in hypertension. British Medical Journal 301: 1172–1173, 1990

    Article  PubMed  CAS  Google Scholar 

  • Swales JD. Antihypertensive drugs and plasma lipids. British Heart Journal 66: 409–410, 1991

    Article  PubMed  CAS  Google Scholar 

  • Veterans Administration Cooperative Study Group. Captopril: evaluation of low doses, twice daily sessions and the addition of diuretic for the treatment of mild to moderate hypertension. Clinical Science 63: 443s–445s, 1982

    Google Scholar 

  • Weiland SK, Keil U, Spelsberg A, Hense HW, Hartel U, et al. Diagnosis and management of hypertension by physicians in the Federal Republic of Germany. Journal Hypertension 9: 131–134, 1991

    Article  CAS  Google Scholar 

  • Weinstein MC, Stason WB. Hypertension: a policy perspective. Harvard University Press, Cambridge, Massachussetts, 1976

    Google Scholar 

  • World Hypertension League. Physical exercise in the management of hypertension: a consensus statement by the World Hypertension League. Journal of Hypertension 9: 283–287, 1991

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Channing Laboratory, The Department of Medicine, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA

    Ichiro Kawachi

Authors
  1. Ichiro Kawachi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kawachi, I. Economic Factors in the Initiation of Antihypertensive Therapy. PharmacoEconomics 2, 324–334 (1992). https://doi.org/10.2165/00019053-199202040-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199202040-00007

Keywords

Search

Navigation