Antihypertensive therapy: how to evaluate the benefits

The American Journal of Cardiology
A Zanchetti

Abstract

For more than 30 years, the benefits of antihypertensive therapy have been assessed in randomized trials that monitor cardiovascular events. Even greater benefits can result if prevention of (1) congestive heart failure, (2) left ventricular hypertrophy, and (3) progression to more severe hypertension is taken into consideration. However, quantifying the benefits in order to calculate the cost-effectiveness of treatment is not easy. Taking absolute risk and benefit as the only guide to treatment decisions may result in limiting therapy only to elderly hypertensive patients and hypertensive patients with complications. Furthermore, randomized trials, of which the duration is necessarily short, are likely to underestimate treatment benefits. An alternative to such an approach is the actuarial approach: treatment benefits are calculated from the actuarial data showing the reduction in life expectancy associated with any given blood pressure increase. The cost of antihypertensive therapy per year of life gained calculated in this way is much lower than the cost calculated from randomized trials. In an uncertain area such as that of cost-effectiveness evaluation, it is important that both approaches are taken into consideration by p...Continue Reading

References

Jan 1, 1992·Clinical and Experimental Hypertension. Part A, Theory and Practice·A Zanchetti
Oct 14, 1982·The New England Journal of Medicine·UNKNOWN Hypertension Detection and Follow-up Program Cooperative Group
Nov 1, 1995·The Australian & New Zealand Journal of Obstetrics & Gynaecology·G R Casper, S M Garland
Apr 1, 1996·Clinical and Experimental Hypertension : CHE·A Zanchetti
Jun 1, 1996·Journal of Hypertension·S MacMahon
Jul 1, 1996·Journal of Hypertension·J D Swales
Sep 1, 1996·Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension·A Zanchetti
Feb 7, 1995·PharmacoEconomics·M Johannesson
Jan 1, 1961·Annals of Internal Medicine·J J HUTCHINSON

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Citations

Sep 13, 2005·Pharmacology & Therapeutics·Francisco J López-Hernández, José M López-Novoa
Nov 1, 2002·Journal of Hypertension·Stanley S Franklin, Nathan D Wong
Jun 5, 2003·Journal of Hypertension·UNKNOWN European Society of Hypertension-European Society of Cardiology Guidelines Committee

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