Abstract
BackgroundThe PAST-BP trial found that using a lower systolic blood pressure target (<130 mmHg or lower versus <140 mmHg) in a primary care population with prevalent cerebrovascular disease was associated with a small additional reduction in blood pressure (2.9 mmHg).ObjectivesTo determine the cost effectiveness of an intensive systolic blood pressure target (<130 mmHg or lower) compared with a standard target (<140 mmHg) in people with a history of stroke or transient ischaemic attack on general practice stroke/transient ischaemic attack registers in England.MethodsA Markov model with a one-year time cycle and a 30-year time horizon was used to estimate the cost per quality-adjusted life year of an intensive target versus a standard target. Individual patient level data were used from the PAST-BP trial with regard to change in blood pressure and numbers of primary care consultations over a 12-month period. Published sources were used to estimate life expectancy and risks of cardiovascular events and their associated costs and utilities.ResultsIn the base-case results, aiming for an intensive blood pressure target was dominant, with the incremental lifetime costs being £169 lower per patient than for the standard blood pressure target with a 0.08 quality-adjusted life year gain. This was robust to sensitivity analyses, unless intensive blood pressure lowering reduced quality of life by 2% or more.ConclusionAiming for a systolic blood pressure target of <130 mmHg or lower is cost effective in people who have had a stroke/transient ischaemic attack in the community, but it is difficult to separate out the impact of the lower target from the impact of more active management of blood pressure.
Highlights
The Prevention AfTer Stroke – Blood Pressure (PAST-BP) trial found that using a lower systolic blood pressure target (
A Markov model was constructed to estimate the longterm cost effectiveness, in terms of the cost per qualityadjusted life year (QALY) gained, of an intensive target strategy versus a standard target strategy for BP lowering in people with a history of stroke or transient ischaemic attack (TIA)
Compared to a standard BP target of 140 mmHg systolic blood pressure (SBP), intensive BP lowering was in a position of dominance, being cheaper and more effective
Summary
The PAST-BP trial found that using a lower systolic blood pressure target (
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