Economic factors in the initiation of antihypertensive therapy

Optimal management of hypertension involves finding a balance among its benefits, risks and costs. Cost-effectiveness analysis helps to clarify not only the trade-offs between the costs and benefits of treatment, but also the trade-offs between the risks and benefits, and the costs and quality of therapy. Existing analyses of hypertension treatment suggest a consistent set of strategies by which cost-effectiveness may be improved. These include strategies to increase the effectiveness of therapy, such as excluding false-positive diagnoses of hypertension, and according higher priority to treating patients with sustained elevations of diastolic blood pressure above 100mm Hg. A complementary set of strategies involve reducing the costs of therapy by prescribing lower-cost first-step regimens, making use of the minimum effective dose for particular medicines and attempting step-down therapy for suitable patients. Consideration of economic factors in initiating hypertension treatment is consistent with sound clinical practice.