Big changes needed for treating blood pressure, new study says
In a landmark study published in The Lancet today, a global team of researchers has shown that if doctors simply changed the way they determine who to administer blood pressure-lowering treatment to, many less people would die or suffer serious heart conditions.
With the health care costs of cardiovascular disease, coronary heart disease and stroke costing £12 billion annually (2009) in the United Kingdom alone, according to the British Heart Foundation, improving delivery offers great opportunities to save on healthcare spending. Researchers from The George Institute for Global Health, an international research institute supported by the Oxford Martin School, argue that clinicians should use an assessment of risk to allocate blood pressure-lowering treatment, not the blood pressure level alone.
The researchers say a radical overhaul is needed for guidelines that govern the prescription of blood pressure-lowering medication.
“What this research shows is that it’s not just a patient’s blood pressure that matters when deciding who to treat,” says Professor Neal, a lead researcher on the project from The George Institute at the University of Sydney. “Using this new approach you can treat less people but prevent more strokes and heart attacks. It’s a win for patients and should be a win for the government’s budget too.”
Current guidelines for blood pressure lowering treatment are focused on just the blood pressure level. This research shows how taking into account factors like the age of the patient and whether they have other health problems like diabetes can help to better target treatment.
“These landmark global research results show that by better targeting our blood pressure treatments, we can deliver better health care, more efficiently,” said Professor Terry Dwyer, Executive Director of The George Institute for Global Health, United Kingdom.
“This is such an important area for the health system to get right,” said Professor Dwyer, who noted that according to the National Health Service (NHS), coronary heart disease (CHD) is the leading cause of death both in the UK and worldwide. It is responsible for around 74,000 deaths in the UK each year. About 1 in 5 men and 1 in 8 women die from CHD.
“It can be hard for patients and doctors to get their heads around,” explained Professor Neal, “because this is completely contrary to how most people think about the use of blood pressure lowering drugs. For example, many high-risk people without hypertension stand to gain a lot from blood pressure lowering treatment.”
Following a very similar line of thinking, the prescription of cholesterol lowering treatment shifted to a ‘risk-based’ approach many years ago with profound implications – modelling showed that less patients could be treated for a reduced cost, while still preventing more events.
“This study does for blood pressure what we did for cholesterol treatment a decade ago,” said Professor Neal. “The blood pressure field has lagged far behind because we haven’t had this type of evidence until now.”
Researchers in New Zealand pioneered the ‘risk-based approach to blood pressure lowering in the 1990’s and many countries have simple and well established methods for assessing a person’s risk. Currently, however, they are very infrequently used because guidelines are still focused on blood pressure levels.
A billion people around the world have high blood pressure– a condition that causes kidney disease, heart attacks and stroke. High blood pressure is the leading cause of death in the world.
The study was led by The George Institute for Global Health researchers in Australia, Sweden and the United Kingdom, and included data from 11 trials and 67,475 patients.
