CHDS affiliated faculty Karen Smith recently co-authored a cost-effectiveness analysis of intensive blood pressure targets in settings with blood pressure measurement error, with colleagues including CHDS faculty Thomas Gaziano, Nicolas Menzies, and Ankur Pandya.
Despite efficacy in clinical trials, intensive systolic blood pressure (SBP) targets for patients at high cardiovascular disease risk are seldom implemented in routine clinical practice. This is likely due to concerns that intensive targets combined with inaccurate blood pressure measurement could cause overtreatment, greater spending, and higher rates of adverse events. These concerns led previous blood pressure guidelines to recommend a target of <130 mm Hg over a more intensive target of <120 mm Hg.
Smith and colleagues investigated whether the cost-effectiveness of intensive targets (<120 mm Hg) depended on the degree of error in blood pressure measurement. They developed and validated a disease simulation model of hypertension treatment and used it to simulate the lifetime health benefits and costs of intensive treatment, varying measurement error. The authors found that intensive targets would be cost-effective in clinics with typical levels of error in a wide range of scenarios. These results affirm decisions to lower SBP targets, such as the recent decision by the American College of Cardiology / American Heart Association to encourage a goal of <120 mm Hg in their 2025 guidelines.
Smith graduated from the Harvard PhD Program in Health Policy in May, 2024, and is currently an Investigator in the Department of Orthopedic Surgery at Brigham and Women’s Hospital.
Learn more: Read the publication, Effect of Systolic Blood Pressure Measurement Error on the Cost-Effectiveness of Intensive Blood Pressure Targets
Learn more: Read the related publication, Surveying the New Landscape of Blood Pressure Control
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