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Lower Blood Pressure Could Help Improve Outcomes, Lower Overall Costs
The first new high blood pressure guideline in 14 years, released last week, recommends lower targeted blood pressure for all adults. While this will significantly increase the number of U.S. adults considered hypertensive and lead to greater use of high blood pressure medication, the lower blood pressure targets have the potential to help lower adverse health events and improve outcomes.
New Blood Pressure Guideline
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The American Heart Association (AHA) and the American College of Cardiology (ACC) now define high blood pressure as above 130/80 millimeters of mercury (mm Hg) for systolic and diastolic respectively, down from 140/90. This means nearly 46 percent of American adults will now be considered hypertensive, with the prevalence among men under 45 years of age tripling, and women in the same age group doubling. The total number of adults with high blood pressure is expected to increase to 103 million from 72 million under the previous standard blood pressure guideline.
Why it Matters
Second only to cigarette smoking as a preventable cause of death in the U.S., high blood pressure costs more than $46 billion annually in health care and medication costs, according to the Centers for Disease Control and Prevention. High blood pressure is also the most significant, modifiable risk factor for cardiovascular disease (CVD). With about 610,000 deaths — about one in four — annually, heart disease is a leading cause of death for both men and women of all ethnicities in the U.S. In 2016, the nation spent $555 billion to treat CVD — making it America’s costliest disease. By 2035, the cost is estimated to be more than one trillion dollars.
Lowering the prevalence of high blood pressure can improve health outcomes by reducing the risk for CVD, according to Systolic Blood Pressure Intervention Trial (Sprint), a landmark study of more than 9,300 men and women. Among study participants, those assigned with a systolic pressure target below 120 mm Hg saw the incidence of heart attacks, heart failure, and strokes fall by a third and the risk of death by a quarter. The Sprint study, as well as more than 1,000 research reports, formed the basis for the new, lower blood pressure guideline from the AHA and ACC.
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What it Means
For a majority of Americans now considered hypertensive under the new guideline, lifestyle changes will be sufficient to control their blood pressure. Target BP, a joint effort by the American Heart Association and ACC, recommends nonpharmacological interventions such as a heart-healthy DASH diet, reducing sodium intake, increasing physical exercise, weight loss and limiting alcohol intake as the first line of treatment. Treatment with pharmacological means, such as medication therapy, is recommended based on the patient’s stage of hypertension, their medical history, and risk factors for CVD. We expect the number of patients being prescribed high blood pressure medication, as well as those requiring higher doses to control their blood pressure, to increase under the new guideline.
The new guideline could result in an additional 39M prescriptions for blood pressure medications annually
We expect an additional 39 million prescriptions annually, based on a book of business analysis of CVS Caremark data, taking into account that not all members newly diagnosed as having high blood pressure will undergo medication therapy.
However, most medications in this therapy class are available as generics, so any increase in payor cost is estimated to be relatively small. The lower blood pressure targets could also mean more people are reducing their risk of adverse outcomes such as heart attacks, strokes and hospitalization, leading to lower overall health care costs.
The estimated savings for each adherent patient — in avoidable, downstream health care costs — is more than $10 for every dollar spent on medication. For 2016, that is an estimated $4,980 per patient annually, based on the Roebuck estimate inflated to 2016 dollars using the consumer price index.* Based on the number of new patients who may now be on blood pressure medications under the new guideline, that could result in total savings of nearly $21 billion annually across the health care system.*
The greatest challenge for payors will be ensuring that members on blood pressure medications are adherent to their therapy regimens. Medication adherence is critical to successfully controlling high blood pressure and ensuring better outcomes. Nearly 50 percent of patients diagnosed under the old guidelines were unable to lower their blood pressure under the recommended 140/90 mm Hg target. Payors need to ensure that they have the right engagement programs and interventions in place to help members be more adherent to their antihypertensive medication regimens.
Optimizing prescription therapy is key to improving outcomes for chronic conditions that drive a majority of health care spend.
Investing in adherence helps reduce overall health care costs and drive better health outcomes.
*Source: VS Health Analytic Consulting Services, 2017.
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