title: Evaluating the true cost of hypertension management: evidence from actual practice.
abstract: Hypertension is a prevalent and costly disease and drug cost is the most significant driver of total expense. Therefore, medications such as diuretics, with lower acquisition costs, and equal or better trial-based efficacy versus other classes of antihypertensives, are currently recommended as first-line therapy. However, observational data from actual practice suggest that antihypertensive drug acquisition costs alone are a poor predictor of total treatment cost. This review explores other important determinants of cost which must be considered, such as therapeutic turbulence and persistence on therapy, which cannot be measured with validity within a clinical trial environment. Actual practice data reveal that greater turbulence and poorer persistence is associated with older agents such as diuretics, versus newer, more tolerable medications. On the basis of observational evidence, the gap in total treatment cost associated with older versus newer antihypertensives is significantly less than that which is commonly reported and used as an argument for first-line treatment with diuretics. Continued constructive debate over the implications of observational data for the selection of a first-line antihypertensive therapy is warranted.
authors.affiliation: Caro Research Institute, 185 Dorval Avenue, Suite 301, Dorval, Quebec H9S 5J9, Canada. kpayne@caroresearch.com
authors.forename: Krista A
authors.initials: KA
authors.lastname: Payne
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Caro