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Population impact of the 2017 ACC/AHA guidelines compared with the 2013 ESH/ESC guidelines for hypertension
Julien Vaucher1, Pedro Marques-Vidal1, Gérard Waeber1
1Service of Internal Medicine, Lausanne University Hospital, Switzerland.
Insights
The 2017 ACC/AHA hypertension guidelines recommend treatment for more adults than European guidelines, increasing eligibility by 250,000 people. This change impacts hypertension management and healthcare costs in Switzerland.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- The 2017 ACC/AHA hypertension guidelines lowered treatment thresholds for Stage 1 hypertension (130-139/80-89 mmHg), particularly for individuals with cardiovascular disease.
- Previous European guidelines (2013) had different criteria for initiating antihypertensive treatment.
Purpose of the Study:
- To compare the population and economic impact of the 2017 ACC/AHA hypertension guidelines versus the 2013 European guidelines in Switzerland.
- To estimate the number of additional individuals eligible for antihypertensive treatment and the associated costs.
Main Methods:
- Analysis of 4438 participants (aged 45-85) from the CoLaus|PsyCoLaus study (2014-2017).
- Sex and age standardization using the Swiss population (2016) to determine eligibility under both guideline sets.
- Estimation of population-wide annual costs for antihypertensive drug treatment.
Main Results:
- The 2017 ACC/AHA guidelines identified 40.3% of the population as eligible for treatment, compared to 31.3% under the 2013 European guidelines.
- This represents approximately 250,000 additional individuals eligible for treatment.
- The estimated additional annual cost for antihypertensive treatment is 72.5 million CHF (63.0 million EUR).
Conclusions:
- The 2017 ACC/AHA guidelines significantly expand the number of individuals recommended for antihypertensive treatment compared to 2013 European guidelines.
- While aiming for cardiovascular disease prevention, the increased treatment eligibility may lead to higher immediate healthcare expenditures.
- The long-term cost-effectiveness requires further evaluation considering both treatment costs and disease prevention benefits.
Abstract:
Background The 2017 ACC/AHA guidelines on hypertension management recommend the introduction of antihypertensive treatment for patients with new stage 1 hypertension thresholds (130-139/80-89 mm Hg) and with a cardiovascular disease or related condition. We compared the Swiss population and economic impact of antihypertensive treatment of the 2017 ACC/AHA guidelines with the 2013 European guidelines. Methods Analyses were based on 4438 participants (aged 45-85 years; 2448 women) of the CoLaus|PsyCoLaus study recruited between 2014-2017. Participants eligible for antihypertensive treatment according to the 2017 ACC/AHA and 2013 European guidelines were sex and age standardised using the Swiss population for 2016. In addition, we estimated the population-wide annual costs of antihypertensive treatment. Results Individuals eligible for antihypertensive treatment were 40.3% (95% confidence interval 38.5-42.1) and 31.3% (29.7-32.9) according to the 2017 ACC/AHA and 2013 European guidelines, respectively. That difference would translate into approximately 250,000 additional individuals eligible for antihypertensive treatment, corresponding to an additional annual cost of 72.5 million CHF (63.0 million EUR). Conclusion The 2017 ACC/AHA guidelines on the management of hypertension substantially increase the number of individuals eligible for antihypertensive treatment compared to the 2013 European guidelines. While implementation of the 2017 ACC/AHA guidelines is expected to lead to cost reduction by preventing cardiovascular diseases, that reduction might be mitigated by the costs incurred by antihypertensive treatments in a larger proportion of the population.
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