Economic Benefits of Treating High-Risk Hypertension with Angiotensin II Receptor Antagonists (Blockers)
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Hypertension is one of the leading risk factors for cardiovascular disease and represents a major health and economic burden. Most patients with high-or very high-risk hypertension have multiple cardiovascular risk factors with or without accompanying subclinical organ damage or established cardiovascular or renal disease. Patients with severe hypertension or with moderate hypertension and one to two additional risk factors have absolute 10-year risks of cardiovascular disease of 21–30% and 15–20%, respectively. Current European treatment guidelines recommend that antihypertensive therapy be initiated rapidly and aggressively in patients with high-risk hypertension. Most patients require two or more antihypertensive agents to achieve the strict blood pressure target of <130/80 mmHg. This article reviews the existing cost-effectiveness data on the use of angiotensin II receptor antagonists (blockers) [ARBs] in patients with high-risk hypertension. Aggressive ARB treatment of patients in the early (microalbuminuric) stages of diabetic nephropathy has a significant renoprotective effect, delaying the onset of overt (proteinuric) nephropathy. By slowing the progression of these patients to end-stage renal disease, substantial cost savings can be made. There is a paucity of cost-effectiveness data regarding the use of fixed-dose ARB plus thiazide diuretic combination therapies. Longitudinal cost-benefit studies of this attractive and efficacious first-line treatment option are needed.
The author would like to thank Natalie Barker of Wolters Kluwer Health Medical Communications (funded by Bristol-Myers Squibb) for her assistance in writing and editing this review. The author has received research grants and honoraria for advisory tasks from sanofi-aventis and Bristol-Myers Squibb.
- 4.Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007 Jun; 25(6): 1105–87PubMedCrossRefGoogle Scholar
- 10.Council of the European Union. 2586th Council Meeting —Employment, Social Policy, Health and Consumer Affairs. Luxembourg 2004 Jun 1–2 [online]. Available from URL: http://ue.eu.int/Newsroom/ [Accessed 2007 Jun 13]Google Scholar
- 12.American Heart Association. Heart disease and stroke statistics: 2005 update [online]. Available from URL: httpV/www.americanheart. org/downloadable/heart/1105390918119HDSStats 2005Update.pdf [Accessed 2007 Jun 13]Google Scholar
- 13.Organisation for Economic Co-operation Development. OECD health data 2004: a comparative analysis of 30 countries. 2nd ed. [online]. Available from URL: http://www.oecd.org/ health/healthdata/ [Accessed 2007 Jun 13]Google Scholar
- 15.Puska P, Tuomilehto J, Nissinen A, et al., editors. The North Karelia project: 20 year results and experiences. Helsinki: The National Public Health Institute (KTL), 1995Google Scholar
- 20.Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005 Sep 10–16; 366(9489): 895–906PubMedCrossRefGoogle Scholar
- 34.McInnes G, Burke TA, Carides G. Cost-effectiveness of losartan-based therapy in patients with hypertension and left ventricular hypertrophy: a UK-based economic evaluation of the Losartan Intervention for Endpoint reduction in hypertension (LIFE) study. J Hum Hypertens 2006 Jan; 20(1): 51–8PubMedCrossRefGoogle Scholar
- 39.Palmer AJ, Roze S, Valentine WJ, et al. Health economic implications of irbesartan plus conventional antihypertensive medications versus conventional blood pressure control alone in patients with type 2 diabetes, hypertension, and renal disease in Switzerland. Swiss Med Wkly 2006 May 27; 136(21-22): 346–52PubMedGoogle Scholar
- 49.Teo K, Yusuf S, Sleight P, et al. Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trials. Am Heart J 2004 Jul; 148(1): 52–61PubMedCrossRefGoogle Scholar
- 52.After the diagnosis: adherence and persistence with hypertensive therapy. Am J Manag Care 2005; 11 (13 Suppl.): S395-9Google Scholar
- 55.The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002 Dec 18; 288(23): 2981–97CrossRefGoogle Scholar