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Intensive, standard BP treatments confer similar quality of life, mental outcomes
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Patients with hypertension who received intensive treatment had comparable quality of life, mental and satisfaction outcomes compared with patients receiving standard care, according to new data from the SPRINT trial.
A separate analysis found that intensive BP control is cost-effective.
Quality-of-life assessment
Dan R. Berlowitz, MD, MPH, professor of general internal medicine at Boston University School of Medicine, chief of staff at Edith Nourse Rogers Memorial VA Hospital in Bedford, Massachusetts, and director of the Center for Health Quality, Outcomes and Economic Research, and colleagues analyzed data from 9,361 patients aged at least 50 years with a systolic BP between 130 mm Hg and 180 mm Hg. Patients were assigned intensive treatment (n = 4,678) with a systolic BP target of > 120 mm Hg or standard care (n = 4,683) with a systolic BP target > 140 mm Hg.
For the present analysis, patients responded to surveys to assess quality of life, physical and mental health, depressive symptoms and patient satisfaction.
Data were only available up to 48 months, as the trial was stopped early due to the intensive-treatment group having a lower rate of the primary outcome of MI, other ACS, stroke, HF and death from CV causes.
At 1 year, systolic BP was 14.8 mm Hg lower in patients who received intensive treatment vs. standard care (95% CI, 14.3-15.4).
During a follow-up period of 3 years, scores for patient-reported outcomes were stable with no differences between both groups. Similar results were also seen for physical and cognitive function in addition to medication adherence. Patients from both groups reported high satisfaction with their BP care (intensive group, 88.6%; standard group, 88.2%). Sensitivity analyses did not alter the results.
“Translating the current findings into clinical practice presents a challenge and would result in changes in how clinicians manage hypertension in older patients,” Berlowitz and colleagues wrote. “Before patients and clinicians adopt such changes, they will need to be reassured that intensive treatment not only reduces the risk of [CV] events and death, but will result in few side effects as shown in patient-reported assessments.”
Cost-effective patient outcomes
When compared with standard BP control, intensive control of systolic BP prevented CVD events, extended life and did so at a lower cost than common willingness-to-pay thresholds, according to a separate study published in the New England Journal of Medicine.
The cost-effectiveness remained whether the benefits continued for a lifetime or reduced after 5 years, according to researchers.
Adam P. Bress, PharmD, of the department of population health sciences at the University of Utah School of Medicine, and colleagues performed a simulation study that applied SPRINT treatment effects and health care costs to a theoretical cohort of SPRINT-eligible adults. This model calculated lifetime costs of treatment and monitoring in patients with CVD, hypertension and subsequent treatment costs; quality-adjusted life-years (QALYs) for intensive control vs. standard control of systolic BP; and treatment-related risks of serious adverse events and subsequent costs.
The mean number of QALYs would be 0.27 higher among patients who received intensive BP control, and would cost about $47,000 more per QALY gained if there were a cutback in compliance and treatment effects after 5 years. Further, the cost would be about $28,000 more per QALY gained if the treatment effects persisted for the rest of a patient’s life.
Intensive treatment would be cost-effective (51% to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76% to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or continued for the rest of a patient’s life.
Researchers estimated that the cost-effectiveness of the intensive BP control strategy would be fully seen after about 10 to 20 years of treatment.
“Intensive control may prevent [CVD] events in high-risk patients and reduce health care costs, as compared with standard control, but these benefits must be weighed against the increased risk of serious adverse events and higher implementation costs (eg, additional office visits, laboratory tests, and medications),” Bress and colleagues wrote. – by Darlene Dobkowski and Janel Miller
Disclosures: Berlowitz and Bress report no relevant financial disclosures. Please see the studies for all other authors’ relevant financial disclosures.
Perspective
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Sripal Bangalore , MD, MHA, FACC, FAHA, FSCAI
The results are interesting and important. Although none of the results show that patient-related outcomes were better in the intensive when compared with standard BP, it is reassuring to note that none were worse off.
These findings do have implications for clinical practice. It is reassuring to note that in select patients, intensive BP reduction is not associated with worse quality of life. However, on a sobering note, it did not improve quality of life and patients have to weigh extra medication, potential higher adverse effects with the benefits of intensive BP reduction.
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