Abstract P278: Potential Value of Long-term Intensive BP Treatment in 40-year Patients: A Computer Simulation Study

Abstract

Introduction: Intensive blood pressure (BP) goals are considered for high cardiovascular disease (CVD) risk adults ≥50 years old; the long-term value of intensive BP goals in younger high CVD risk patients has not been studied. Objectives: We used individual patient computer simulations to assess the incremental value of intensive BP goals in high CVD risk patients as young as 40 years. Methods: Six age/sex cohorts of 100,000 individuals were assembled by sampling NHANES surveys 1999-2010. BP and other risk factor trajectories were projected from ages 60 to 69, 50 to 69, and 40 to 69 years based on Framingham Offspring Cohort analyses. One BP treatment scenario simulated treating BP <140/90 mmHg in all patients ≥140/90; a second scenario added to the first a goal <BP 130/90 mmHg in patients with systolic BP ≥130 and 10-year CVD risk ≥10%. Costs included added treatment and side-effect costs and avoided CVD costs. Incremental cost-effectiveness ratios (ICERs) assessed changes in costs and quality-adjusted life years due to adding intensive BP goals in each cohort. Results: Intensive goals were generally cost-effective in high-risk CVD risk patients (Table). Treating 40-year old cohorts was the highest value strategy. This was because of large life-year gains when events are prevented early in life and because hypertensive 40 year-olds “age into” much higher BPs and CVD risk over time. To illustrate the latter, mean untreated systolic BPs at age 60 were 152, 148, and 146 mmHg, and mean 10-year CVD risk scores were 17%, 15% and 13% for 40-, 50- and 60-year-old male cohorts, respectively. Conclusion: Intensive BP goals were projected to be cost-effective over a 30-year time horizon in high-risk hypertensive patients as young as 40 years old.