Antihypertensive medication versus health promotion for improving metabolic syndrome in preventing cardiovascular events: a success rate-oriented simulation study

Yoichi Ohno,Tsuneo Takenaka,Mayuko Hanyu,Makiko Satoh,Hiromichi Suzuki,Satomi Shibazaki,Takashi Miyazaki,Ryuichiro Araki,Hirokazu Okada

doi:10.1186/1472-6947-11-8

Yoichi Ohno, Tsuneo Takenaka + Show 7 more

Open Access

https://doi.org/10.1186/1472-6947-11-8

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Abstract

BackgroundIn practice, it is difficult to compare the effectiveness of traditional antihypertensive treatment with that of health promotion in reducing incidence rate of cardiovascular disease (IRCVD, events/year). This simulation study compared the effectiveness of two approaches to reducing IRCVD in a sample population: a traditional approach, in which high-risk patients are treated with conventional antihypertensive medications, and a population-based approach, in which subjects participate in a health promotion program.MethodsWe constructed a simulation model for a sample population of middle-aged Japanese men whose systolic blood pressure (SBP) levels are normally distributed (130 ± 20 mm Hg). The principal assumption was that IRCVD increases exponentially according to SBP. The population IRCVD was calculated as the product of the distribution of SBP multiplied by IRCVD at each SBP. The cumulative IRCVD was calculated by the definite integral from the lowest to the highest SBP of IRCVD at each SBP level. The success rates were calculated according to SBP and metabolic risk profiles in the two approaches, respectively.ResultsThe reduction in IRCVD was twice as large for antihypertensive medications as it was for health promotion in several situations. For example, if adherence to antihypertensive treatment occurred at a realistic level, the decrease in IRCVD was estimated at 9.99 × 10-4. In contrast, even if the health program was promoted optimistically, the decrease in IRCVD was estimated at 4.69 × 10-4.ConclusionsThe success rate-oriented simulation suggests that prescribing antihypertensive medications is superior to promoting the health promotion program in reducing IRCVD in virtual middle-aged Japanese men.

Highlights

It is difficult to compare the effectiveness of traditional antihypertensive treatment with that of health promotion in reducing incidence rate of cardiovascular disease (IRCVD, events/year)
The number of health checks (NHC) to rescue one cardiovascular event per year is much lower for antihypertensive medications than it is for health promotions in corresponding virtual situations
In the case of k = 20, l = 100, and m = 140, if we prescribe antihypertensive medicines to patients whose systolic blood pressure (SBP) is not less than 150, accessibility to the medical office is 0.03 or the usual situation, the target SBP is set to 140 mm Hg, and the success rate is 0.7, ΔIRCVD and NHC are estimated at 9.99 × 10-4 and 1001, respectively

Summary

Introduction

It is difficult to compare the effectiveness of traditional antihypertensive treatment with that of health promotion in reducing incidence rate of cardiovascular disease (IRCVD, events/year). This simulation study compared the effectiveness of two approaches to reducing IRCVD in a sample population: a traditional approach, in which high-risk patients are treated with conventional antihypertensive medications, and a population-based approach, in which subjects participate in a health promotion program. The Japanese Society of Hypertension (JSH) 2009 hypertension treatment guidelines insist that hypertensive subjects (BP > 140/90 mm Hg) with metabolic syndrome should visit primary physicians before initiating the health promotion. Direct evidence is still lacking with regard to the beneficial effects of lifestyle interventions (except for smoking cessation) on cardiovascular events [8,9]

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