Cost Of Antihypertensive Treatment Research Articles

Evaluation of the management of hypertension among stroke patients in a neurology department of Côte d'Ivoire

Reducing blood pressure after stroke is important to prevent recurrent stroke, but we have no data about the control of blood pressure in our context. The purpose of this study was to assess management of hypertension among post-stroke patients in a neurology department. It was a retrospective study involving hypertensive stroke patients. They were followed up at 1, 3, 6 and 12 months after discharge. 141 patients fulfilled the inclusion criteria. The mean age was 61 years. Almost all patients (94.3%) received a dual antihypertensive therapy combining mainly an ACE inhibitor and a diuretic (70.2%). During follow-up, only 76 patients were assessed at M1, 50 at M3, 44 at M6 and 42 at M12. The average monthly cost of antihypertensive treatment was 13,771 CFA francs (21 euros). Non-adherence to antihypertensive medication were mostly noted in widows, patients without occupation, those with low education and no health insurance. At one year, blood pressure was controlled in 80% of the 42 patients still present. Non-control of blood pressure was related to poor therapeutic compliance (p<0.05). This study highlights follow-up issues in hypertensive post-stroke patients with a high number of lost to follow-up. Blood pressure was controlled in patients who were regularly followed and adherent to antihypertensive treatment.

Would Anti-Hypertensive Treatment be a Risk Factor for National Health Budget of Turkey in 2023?

Abstract This study aims to predict the prevalence of hypertension and the cost of anti-hypertensive treatment in future by analyzing the adults diagnosed with hypertension and the drugs prescribed for their treatment in Turkey during a period of five years. This study reviews data related to the patients diagnosed with hypertension amongst the individuals registered within the Medula database of the Turkish Social Insurance Institution from 2009 to 2013. A significant and gradual increase was specified in the prevalence of hypertension during the study period. The number of female patients was significantly higher than the number of male patients over the passing years. The number of anti-hypertensive drug boxes consumed was significantly increased during the study period. Surprisingly, the number of anti-hypertensive boxes annually consumed by the hypertensive patients remained statistically similar between 2009 and 2013. A significant increase was noted in the prescription of angiotensin II receptor blockers, beta blockers, and angiotensin converting enzyme inhibitors during the study period. The cost of anti-hypertensive treatment was found to decrease by 36.7% during the study period. The economical measures currently adopted for drug pricing are successful but health policies developed for the prevention of hypertension are inadequate. Keywords: Anti-hypertensive drugs; hypertension; pharmacoeconomy; prevalence

Economic Evaluation of Primary Prevention of Cardiovascular Diseases in Mild Hypertension: A Scenario Analysis for the Netherlands

BackgroundIn the Netherlands, antihypertensive treatment for patients with mild hypertension is recommended if the 10-year cardiovascular disease (CVD) risk exceeds 20%. Recent evidence suggests that lifelong CVD risk estimates might be more informative than 10-year ones. In addition, the cost of antihypertensive treatment in the Netherlands has decreased during the last decade. ObjectiveThe aim of this study is to estimate the cost-effectiveness of lowering systolic blood pressure (SBP) in patients ineligible for treatment in both a 10-year and a lifetime horizon. MethodsA Markov model was developed to assess the cost-effectiveness of SBP reduction compared with no reduction in patients with mild hypertension and low CVD risk. Modified SCORE (Systematic Coronary Risk Evaluation) risk estimates were used to predict fatal and nonfatal CVD events. We analyzed scenarios for different age groups, sexes, and SBP reductions. Specifically, SBP reductions due to hydrochlorothiazide (HCT) 25 mg and hypothetical reductions with HCT 12.5 mg-losartan 50 mg combination were assumed. Parameter uncertainty was assessed through a probabilistic sensitivity analysis. ResultsIn a 10-year horizon, in scenarios of SBP reduction with HCT 25 mg, the incremental cost-effectiveness ratio (ICER) estimates for men varied across different ages in the range of €6032 to €58,217 per life-year gained, whereas for women ICER estimates were in the range of €12,345 to €361,064 per life-year gained. In a lifetime horizon, the cost-effectiveness estimates were favorable for both sexes. In scenarios of hypothetical SBP reductions, more favorable ICER estimates compared with no reduction were found. A large uncertainty around the cost-effectiveness estimates was observed among all scenarios. ConclusionLarger SBP reductions were found to be cost-effective in both a 10-year and lifetime horizon. These findings might call for more aggressive SBP reductions in patients with mild hypertension. However, a high level of uncertainty surrounds these cost-effectiveness estimates because they are based on CVD risk prediction modeling.

Antihypertensive therapy among newly treated patients: An analysis of adherence and cost of treatment over years.

To perform a time-trend analysis of adherence and cost of antihypertensive treatment over four years. A population-based retrospective cohort study was conducted. We included subjects ≥18 years, and newly treated for hypertension with diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers between 01 January 2004 and 31 December 2007. One-year adherence to antihypertensive therapy was calculated and classified as low, low-intermediate, intermediate, high-intermediate, and high. The direct cost of antihypertensive medications was evaluated. We included data for a total of 105,512 patients. The number of newly treated subjects decreased from 27,334 in 2004 to 23,812 in 2007, as well as antihypertensive drug therapy cost which decreased from €2,654,166 in 2004 to €2,343,221 in 2007. On the other hand, in the same time frame, the percentage of adherent newly treated subjects increased from 22.9% to 28.0%. Compared with subjects initiated on angiotensin receptor blockers (odds ratio [OR] = 1), the risk of nonadherence was higher in those initiated on angiotensin-converting enzyme inhibitors (OR = 1.19), combination therapy (OR = 1.44), beta-blockers (OR = 1.56), calcium channel blockers (OR = 1.67), and diuretics (OR = 4.28). The findings of the present study indicate that suboptimal adherence to antihypertensive medication occurs in a substantial proportion of treated patients, and improvements in treatment adherence were obtained but are still unsatisfactory.

Observational Study of Hypertension in Matelica, Italy (Matelica Hypertension Study)

This study summarizes the results of an epidemiological investigation carried out on the occasion of the Second World Hypertension Day (May 13, 2006) in the city of Matelica in the Region of the Marches, Central Italy. In all, 518 subjects (298 males, average age 52.3 years; 220 females, average age 55 years) with either diagnosed hypertension or who were thought to be normotensive had arterial blood pressure measured. Other cardiovascular risk factors and the costs of pharmacological treatment for hypertension were assessed as well. In 72.46% of examined subjects, arterial blood pressure levels averaged ≥140–90 mmHg if non-diabetic and ≥130–80 mmHg if diabetics. A total of 48.14% of individuals assumed in anamnesis to be normotensive had arterial blood pressure levels higher than the above values and were therefore found to have hypertensive values. The cost of anti-hypertensive treatment in the area of Matelica averages €543.7/patient/year. The present data, which are in line with those of other epidemiological studies performed in Italy, confirm the view that arterial hypertension control in Italy is still largely unsatisfactory. This observation should stimulate both health and specific medical measures to counter the risk of complications of arterial hypertension in aged populations, such as those present in the territory examined.

Cost implications of development of diabetes in the ALPINE study

To present a cost-effectiveness analysis of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation study (ALPINE). In newly diagnosed hypertensive individuals as yet untreated with drugs, the ALPINE study compared the 1-year metabolic effects of inexpensive treatment with a diuretic (hydrochlorothiazide), alone or in combination (84%) with a beta-adrenoceptor blocker (atenolol), with that of newer but also more expensive antihypertensive treatment with an angiotensin II receptor blocker (candesartan), alone or in combination (71%) with a calcium antagonist (felodipine). No crossover of medication was allowed. The cost-effectiveness analysis included costs for antihypertensive treatment during follow-up, and lifetime costs for care of diabetes mellitus diagnosed during follow-up. Cost per patient was calculated using Swedish prices and costs, translated into US dollars (US$), at 2004 prices. Diabetes mellitus was diagnosed in nine patients during the 1-year follow-up period of the study, eight in the hydrochlorothiazide group (4.1%) and one (0.5%) in the candesartan/felodipine group (P < 0.05). The cost of antihypertensive treatment per patient was US$92 in the hydrochlorothiazide/atenolol group and US$422 in the candesartan/felodipine group. Lifetime cost for care of diabetes mellitus per patient in the two groups was US$1013 and US$127, respectively. Total cost per patient was US$556 less in the candesartan/felodipine group. In sensitivity analyses, the outcome for the candesartan/felodipine group ranged from cost savings to an incremental cost of US$30 000 per case of diabetes mellitus prevented. In all analyses but one, the additional cost for antihypertensive treatment in the candesartan/felodipine group could be balanced by the reduced lifetime cost for care of diabetes mellitus. The results suggest that an antihypertensive treatment strategy with candesartan and felodipine may have a favourable health economic impact in the longer term.

Eating habits and intensity of medication in elderly hypertensive outpatients.

Several dietary factors have been shown to lower blood pressure in elderly patients in clinical trials, but it is not known how eating habits affect blood pressure control in outpatients treated with antihypertensive drugs. We obtained data on dietary information regarding food groups rich in potassium, magnesium, and calcium by submitting a questionnaire to 190 elderly outpatients. Blood pressure levels and the intensity and cost of antihypertensive treatment were obtained from clinical records. The mean age and blood pressure were 72.3 +/- 9.3 years and 138.7 +/- 15.2/74.6 +/- 8.8 mmHg, respectively. Patients were divided into three groups on the basis of the intensity of medication: the LS group (n=52), treated with a low dose of a single drug; the HS group (n=95), treated with a high dose of a single drug; and the M group (n=43), treated with multiple drugs. Average age, body mass index, blood pressure levels, and extent of target organ damage were similar among the three groups. Intake frequency (rarely, once or twice per week, 3 to 6 times per week, or every day) of the food groups was compared among the three groups. The LS group ate fruit (p < 0.05) and seaweed (p < 0.01) with significant frequency compared with the other groups, whereas milk and dairy products were taken with similar frequency by all groups. The monthly cost of antihypertensive medications averaged 17,218 +/- 620 yen in the LS group, 17,746 +/- 375 yen in the HS group, and 20,066 +/- 1,364 yen in the M group. These data suggest that habitual intake of foods rich in potassium and magnesium are associated with reduced intensity and cost of medication and with preservation of blood pressure control in elderly hypertensive outpatients.

Trends in Antihypertensive Drug Use in the United States

<h3>Context.</h3> —The choice of pharmacological treatment for the approximately 50 million people in the United States with hypertension has important therapeutic and financial implications. <h3>Objectives.</h3> —To describe national antihypertensive medication prescribing patterns for 1992 and 1995; to explore the influence of the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V), published in 1993, which recommended diuretics and β-blockers as firstline antihypertensive therapy unless contraindicated; and to estimate the impact of these prescribing patterns on the cost of antihypertensive treatment. <h3>Design.</h3> —All prescriptions for drugs approved for the treatment of hypertension dispensed by 35000 retail pharmacies were tabulated for 1992 and 1995 (62% of all US retail pharmacies were surveyed). <h3>Main Outcome Measures.</h3> —Number of prescriptions for each dosage form of medication and national cost estimates based on wholesale costs of medications dispensed. <h3>Results.</h3> —In 1992, of the 10 most frequently prescribed antihypertensive drugs, 3 were calcium antagonists, 3 were angiotensin-converting enzyme (ACE) inhibitors, 3 were β-blockers, and 1 was the combination of triamterene and hydrochlorothiazide. In 1995,4 were calcium antagonists, 3 were ACE inhibitors, 1 was a β-blocker, 1 was the combination of triamterene and hydrochlorothiazide, and 1 an a-blocker. In 1992, calcium antagonists accounted for 33% of antihypertensive prescriptions compared with 38% in 1995, ACE inhibitor use went from 25% to 33%, β-blocker use from 18% to 11% and diuretic use from 16% to 8%. The estimated wholesale costs for calcium antagonists in 1995 dollars increased from $2.67 billion in 1992 to $2.86 billion in 1995; ACE inhibitor costs increased from $1.37 billion to $1.67 billion; costs for diuretics declined from $353 million to $168 million; and costs for β-blockers declined from $763 million to $433 million. <h3>Conclusions.</h3> —From 1992 to 1995 use of calcium antagonists and ACE inhibitors for treatment of hypertension increased and diuretics and β-blockers declined, suggesting that the recommendations from JNC V had little effect on prescribing patterns. The cost implications of these practice patterns are enormous.

Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators

Ambulatory blood pressure (ABP) monitoring is used increasingly in clinical practice, but how it affects treatment of blood pressure has not been determined. To compare conventional blood pressure (CBP) measurement and ABP measurement in the management of hypertensive patients. Multicenter, randomized, parallel-group trial. Family practices and outpatient clinics at regional and university hospitals. A total of 419 patients (> or =18 years), whose untreated diastolic blood pressure (DBP) on CBP measurement averaged 95 mm Hg or higher, randomized to CBP or ABP arms. Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the average daytime (from 10 AM to 8 PM) ambulatory DBP (n=213) or the average of 3 sitting DBP readings (n=206). If the DBP guiding treatment was above (>89 mm Hg), at (80-89 mm Hg), or below (<80 mm Hg) target, 1 physician blinded to the patients' randomization intensified antihypertensive treatment, left it unchanged, or reduced it, respectively. The CBP and ABP levels, intensity of drug treatment, electrocardiographic and echocardiographic left ventricular mass, symptoms reported by questionnaire, and cost. At the end of the study (median follow-up, 182 days; 5th to 95th percentile interval, 85-258 days), more ABP than CBP patients had stopped antihypertensive drug treatment (26.3% vs 7.3%; P<.001), and fewer ABP patients had progressed to sustained multiple-drug treatment (27.2% vs 42.7%; P<.001). The final CBP and 24-hour ABP averaged 144.1/89.9 mm Hg and 129.4/79.5 mm Hg in the ABP group and 140.3/89.6 mm Hg and 128.0/79.1 mm Hg in the CBP group. Left ventricular mass and reported symptoms were similar in the 2 groups. The potential savings in the ABP group in terms of less intensive drug treatment and fewer physician visits were offset by the costs of ABP monitoring. Adjustment of antihypertensive treatment based on ABP monitoring instead of CBP measurement led to less intensive drug treatment with preservation of blood pressure control, general well-being, and inhibition of left ventricular enlargement but did not reduce the overall costs of antihypertensive treatment.

Antihypertensive Treatment Based on Conventional or Ambulatory Blood Pressure Measurement

Context. —Ambulatory blood pressure (ABP) monitoring is used increasingly in clinical practice, but how it affects treatment of blood pressure has not been determined. Objective. —To compare conventional blood pressure (CBP) measurement and ABP measurement in the management of hypertensive patients. Design. —Multicenter randomized, parallel-group trial. Setting —Family practices and outpatient clinics at regional and university hospitals. Participants. —A total of 419 patients (-18 years), whose untreated diastolic blood pressure (DBP) on CBP measurement averaged 95 mm Hg or higher, randomized to CBP or ABP arms. Interventions. —Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the average daytime (from 10 am to 8 pm) ambulatory DBP (n=213) or the average of 3 sitting DBP readings (n=206). If the DBP guiding treatment was above (>89 mm Hg), at (80-89 mm Hg), or below ( Main Outcome Measures. —The CBP and ABP levels, intensity of drug treatment, electrocardiographic and echocardiographic left ventricular mass, symptoms reported by questionnaire, and cost. Results. —At the end of the study (median follow-up, 182 days; 5th to 95th percentile interval, 85-258 days), more ABP than CBP patients had stopped anithypertensive drug treatment (26.3% vs 7.3%; P P Conclusions. —Adjustment of antihypertensive treatment based on ABP monitoring instead of CBP measurement led to less intensive drug treatment with preservation of blood pressure control, general well-being, and inhibition of left ventricular enlargement but did not reduce the overall costs of antihypertensive treatment.

Benefit and costs of anti-hypertensive treatment.

Hypertension is common throughout the world and represents the single greatest risk factor for increasing cardiovascular mortality, cardiovascular morbidity and overall mortality. Diseases associated with hypertension are not only, in general, of a chronic disabling nature, but, in most instances, require frequent hospitalization, with expensive drug treatment and management. Stroke, coronary heart disease, congestive heart failure and chronic renal insufficiency represent the most commonly encountered corollaries of inadequately treated hypertension. Anti-hypertensive treatment is accompanied by a reduction of hypertension-related cardiovascular risk and a clearcut benefit in terms of reduced incidence of major cardiovascular complications of hypertension and overall mortality. This benefit has frequently been underestimated in many clinical trials. Attempts to improve the cost-benefit ratio have included the use of treatment strategies based upon 24-h control of blood pressure, since it has been demonstrated that hypertension-related end-organ damage correlates more closely with 24-h average blood pressure and with 24-h blood pressure variability than with blood pressure measured in the clinic. It is hoped that new anti-hypertensive agents, which smoothly reduce 24-h blood pressure profile, will further reduce the incidence of hypertension-related end-organ damage.

Selective versus nonselective beta adrenoceptor antagonists in hypertension.

The application of cost-effectiveness methodology is particularly important in widespread diseases such as hypertension. However, because prospective cost-effectiveness analyses comparing different antihypertensive drugs are not currently available, differences in the cost effectiveness of these drugs can only be estimated. The purpose of this review is to estimate and compare the costs of drug therapy with selective and nonselective beta adrenoceptor antagonists in hypertension. The global costs of antihypertensive treatment are largely determined by drug costs. In most countries, drug costs do not appear to vary substantially between beta 1-selective and nonselective beta-blockers. The adverse sequelae of hypertension include stroke, myocardial infarction, cardiac hypertrophy and renal failure. There are no obvious differences in effect on stroke and cardiac hypertrophy between beta 1-selective and nonselective beta-blockers. However, compared with beta 1-selective antagonists, nonselective drugs might be less effective in preventing myocardial infarction in smokers and may impair renal function in patients with both increased peripheral resistance and declining cardiac output. There is a clear difference between beta 1-selective and nonselective beta-blockers on quality-of-life (QOL) perception. During treatment with nonselective beta-blockers, QOL perception is lower than during treatment with beta 1-selective drugs. Preservation of quality of life during long term antihypertensive treatment deserves considerable weight in economic analyses. Consequently, the more favourable effects of beta 1-selective agents on quality of life may outweigh the possible higher costs of these drugs, and suggest that beta 1-selective agents may be more cost effective than nonselective beta-blockers.

Effect of a Clinical Pharmacist Program on the Cost of Hypertension Treatment in an HMO Family Practice Clinic

This study evaluated the impact of a clinical pharmacy service on the cost of antihypertensive drug therapy in an HMO family practice clinic. The service was provided to five family practice physicians. Pharmacists identified hypertensive patients prior to their regularly scheduled office visits from April through June 1986. Patient's medical records and computerized drug files were reviewed, and written recommendations for drug therapy changes were placed in patients' medical record by the pharmacists. When appropriate, pharmacists alerted prescribers to lower cost alternatives. A matched control group of physicians was selected. Hypertensive patients were identified retrospectively in the control group. We found that the cost of antihypertensive drug therapy was significantly higher for study physicians' patients when compared with control physicians' patients in the period prior to implementing the service. The difference between the two groups was not significant after six months. Clinical pharmacist intervention decreased the average cost of antihypertensive treatment from 33.4 to 27.2 cents per day.

Cost of antihypertensive treatment: A point of view from India

In India, expenditure on the treatment of all patients with mild hypertension is not cost effective. Nonpharmacologic treatment is encouraged.

Subjective Costs of Antihypertensive Treatment

A method for surveying side-effects in the hypertension clinic of a district general hospital is described. A high frequency of complaints was confirmed. Impairment of sexual activity in the sexually active was reported by 23 (48%) men and 10 (23%) women. A previous lack of data from women on this subject may have led to the unsafe conclusion that drugs which can cause impotence in men are necessarily more suitable for women. The survey method is capable of identifying susceptible patients who may then be asked to co-operate in further research.