Epidemiological and cost implications of antihypertensive treatment for the prevention of cardiovascular disease.
The major risk factors for coronary disease are blood pressure, blood lipids and cigarette smoking. Major advances have been made over the past 20 years in altering these factors and this has been accompanied by a dramatic reduction in new incidence myocardial infarction (MI) and stroke. Several questions remain however, concerning the best treatment approaches for 'mild' hypertension (DBP = 90-104 mmHg). One major question is the potential ability of different classes of antihypertensive drugs to prevent fatal and non-fatal coronary heart disease. Underscoring this question is the recognition that drug classes differ in their lipid effects. Thiazide diuretics tend to increase total and low density lipoprotein (LDL)-cholesterol, increase triglycerides and slightly lower high density lipoprotein (HDL)-cholesterol. On the other hand alpha 1-antagonists have been shown to influence lipids favourably by lowering total cholesterol, LDL-cholesterol and increasing HDL-cholesterol. Other agents such as calcium channel blockers and ACE inhibitors appear to be lipid neutral. The cost effectiveness of various treatments for hypertension depends not only on direct drug costs but also on the less well-defined indirect costs associated with possible differences in disease rates between treatments. Estimates of disease occurrence with various lipid changes can be modelled after the results of the Coronary Primary Prevention Trial (CPPT) and cost estimates of various diseases (i.e. acute MI) can be estimated from diagnosis-related group data, insurance data and physician survey data.(ABSTRACT TRUNCATED AT 250 WORDS)
Grimm
R H
RH
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55455.
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003327:Coronary Disease / Q000209:etiology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy / Q000191:economics; D008055:Lipids / Q000097:blood; D012307:Risk Factors
D000959:Antihypertensive Agents; D008055:Lipids