Blood Pressure Guidelines: Is Change Coming?

Michael R. Page, PharmD, RPh
Published Online: Wednesday, December 4, 2013
Using a benefit-based approach instead of a treat-to-target approach in determining how to treat hypertension could help prevent more cardiovascular events with less medication.

A more individualized set of treatment guidelines for prescription of blood pressure–lowering medications could prevent more cardiovascular events while using less medication than is the case with current guidelines, according to the results of a new study.
According to study authors, the current approach, based on blood pressure targets, has led some patients to overuse antihypertensive medications and other patients to underuse the medications. Instead of treating to a target level, the new study advises prescribers to decide which patients are the best candidates for antihypertensive treatment by assessing each patient's cardiovascular risk. The study was published in the November 19, 2013, issue of Circulation.
The researchers used data from the National Health and Nutrition Examination Survey (NHANES) III to determine the effects of a 5-year course of antihypertensive medication in terms of quality-adjusted life-years. The data was representative of 176 million Americans between 30 and 85 years of age with no history of severe congestive heart failure and no history of cardiovascular events (stroke or myocardial infarction).
For more than half of patients (55%), an antihypertensive regimen based on the treat-to-target approach would be identical to the regimen with the benefit-based approach. However, over 5 years, the benefit-based approach reduced medication use by 6% while preventing 900,000 more cardiovascular events and saving 2.8 million more quality-adjusted life years compared with the treat-to-target approach.

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