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Cost-benefit aspects of treatment of hypertension in the elderly
1Health Sciences Centre, Lund University, Sweden.
Insights
Treatment of elderly hypertension with beta-receptor blockers and/or diuretics is a cost-effective strategy for reducing cardiovascular disease risk. Modern alternatives show promise but require further study in elderly populations.
Area of Science:
- Geriatric Medicine
- Cardiovascular Pharmacology
- Health Economics
Background:
- Elderly hypertensive patients require effective and economical treatment strategies.
- Beta-receptor blockers and diuretics have established efficacy in reducing cardiovascular events.
- The cost-effectiveness of hypertension management in the elderly is a critical public health consideration.
Purpose of the Study:
- To evaluate the cost-effectiveness of beta-receptor blockers and/or diuretics for treating hypertension in the elderly.
- To compare the efficacy and cost-effectiveness of older versus newer antihypertensive drug classes in elderly populations.
- To assess the impact of different antihypertensive treatments on cardiovascular disease risk in older adults.
Main Methods:
- Analysis of data from the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension).
- Cost-effectiveness ratio calculations for different treatment groups.
- Review of existing literature on prospective studies of primary hypertension and cardiovascular event reduction.
Main Results:
- Treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective.
- Cost-effectiveness ratios were similar for both men and women.
- Modern antihypertensives (calcium antagonists, alpha 1 blockers, ACE inhibitors) effectively lower blood pressure in the elderly but their cardiovascular event reduction efficacy is less established than older drugs.
Conclusions:
- Beta-receptor blockers and/or diuretics represent a cost-effective approach for managing hypertension in the elderly.
- While newer agents lower blood pressure effectively and are cost-effective when older drugs are contraindicated, their ability to reduce cardiovascular events comparably needs further investigation.
- Ongoing studies are crucial to determine if newer antihypertensives match the cardiovascular benefits of beta-blockers and diuretics in the elderly.
Abstract:
Treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective according to the analyses of the results of the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). The cost-effectiveness ratios are low and of the same magnitude for both men and women. The results with respect to reduced risk of cardiovascular disease in STOP Hypertension are also supported by several other studies using the same groups of drugs. The more modern drugs (calcium antagonists, alpha 1 blockers, and ACE inhibitors) have not proven their efficacy in the reduction of cardiovascular events in prospective studies of primary hypertension. It has, however, been shown that they lower blood pressure well also in the elderly and that they are cost-effective among the elderly if treatment with beta-receptor blockers and/or diuretics is contraindicated, provided that they lower the incidence of cardiovascular disease to the same extent as do beta-receptor blockers and diuretics. Studies tackling this latter question are under way, also in the elderly.