New JNC 8 Hypertension Guidelines Save Lives, Reduce Morbidity, and Lower Costs

January 28, 2015

NEW YORK, NY — The full implementation of the Eighth Joint National Committee (JNC 8) guidelines for the management of adult hypertension could prevent approximately 56 000 cardiovascular events and 13 000 deaths each year in the US, all without increasing costs to the healthcare system, according to a new analysis[1].

The 2014 hypertension guidelines, released at the end of 2013 and reported by heartwire at that time, relax some of the more aggressive JNC 7 target blood pressures and treatment-initiation thresholds in elderly patients and in patients under age 60 with diabetes and kidney disease. Briefly, based on JNC 8, the goal is to treat to less than 150/90 mm Hg in patients over age 60 and 140/90 mm Hg for everybody else.

Published January 28, 2015 in the New England Journal of Medicine with lead investigator Dr Andrew Moran (Columbia University Medical Center, New York), the new cost-effectiveness analysis first showed that approximately 860 000 men and women with existing cardiovascular disease and untreated hypertension would be eligible for antihypertensive medications every year. In this secondary-prevention cohort, treatment would prevent approximately 16 000 cardiovascular events and 6000 deaths from cardiovascular causes.

The largest benefit would be observed among the 8.6 million US adults between the ages of 35 and 74 years with hypertension but without cardiovascular disease who are not currently being treated. For these primary-prevention patients, treating to the blood-pressure targets would prevent approximately 41 000 cardiovascular events and 7000 deaths from cardiovascular causes each year.

If fully implemented, hypertension treatment would save the healthcare system money in men with preexisting cardiovascular disease, in men without cardiovascular disease but with stage 2 hypertension, and in men aged 45 to 74 years old with stage 1 hypertension. It would be cost-effective—defined as <$50 000 per quality-adjusted life-year (QALY) gained—in men 35 to 44 years old with stage 1 hypertension.

For women, treatment was cost saving in those with preexisting cardiovascular disease and in those aged 45 to 74 years old with stage 2 hypertension. It was deemed cost-effective in women aged 35 to 44 years old with stage 2 hypertension and those aged 45 to 74 years with stage 1 hypertension. For the younger women, those aged 35 to 44 years, with stage 1 hypertension and diabetes or chronic kidney disease (CKD), hypertension treatment was moderately cost-effective ($125 000 per QALY gained) and of low value for this same group women without diabetes or CKD.

"These findings suggest that more frequent office visits, home blood-pressure monitoring, pharmacist interventions, or interventions to improve adherence may add substantial value, even if they require an additional annual investment," according to Moran and colleagues.

The study was funded by a grant from the National Heart, Lung, and Blood Institute and the National Institute for Neurological Disorders and Stroke. Disclosures for the authors are listed on the journal website.


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