title: Cost-effectiveness of nitrendipine and hydrochlorothiazide or metoprolol to treat hypertension in rural community health centers in China.
abstract: The objective of this article is to compare blood pressure (BP)-lowing effects of nitrendipine and hydrochlorothiazide and nitrendipine and metoprolol, and estimate the economic effect of these therapies on hypertension.
  
  
  
  Outpatients (N = 793) 18-70 years of age with stage 2 or severe hypertension (SBP ≥ 160 mmHg and/or DBP ≥ 100 mmHg) were recruited from four randomly selected rural community health centers in Beijing and Jilin. After drug wash out, they were randomly divided into nitrendipine and hydrochlorothiazide group or nitrendipine and metoprolol group. The costs of drug treatment for hypertension were calculated and general estimation, whereas effectiveness was measured as a reduction in SBP and DBP at the end of a 24-week study period.
  
  
  
  Overall, 623 patients were eligible for the study and after a 24-week follow-up, SBP and DBP were 131.2/82.2 mmHg for the nitrendipine and hydrochlorothiazide group and 131.4/82.9 mmHg for the nitrendipine and metoprolol group and these were not significantly different (P = 0.7974 SBP and P = 0.1166 DBP). Comparing with nitrendipine and metoprolol, the cost of nitrendipine and hydrochlorothiazide was less, and its effectiveness was similar. The cost/effect ratio (US$/mmHg) was 1.4 for SBP and 2.8 for DBP for the nitrendipine and hydrochlorothiazide group, and 1.9 and 3.8 for the nitrendipine and metoprolol group's SBP and DBP values, respectively. The incremental cost per patient for achieving target BP was 5.1. Adverse events were mild or moderate and there were no differences between treatment groups.
  
  
  
  Treating hypertension with nitrendipine and hydrochlorothiazide was cost-effective than nitrendipine and metoprolol, and these data will allow more reasonable and efficient allocation of limited resources in low-income countries.
authors.affiliation: aDivision of Prevention and Community Health, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China bGeorgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA cDivision of Information Consultation, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China dDepartment of Cardiology, the First Hospital of Jilin University, Jilin eInstitute of Medical Information, the Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Zengwu
authors.initials: Z
authors.lastname: Wang
authors.forename: Zuo
authors.initials: Z
authors.lastname: Chen
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Guang
authors.initials: G
authors.lastname: Hao
authors.forename: Liyuan
authors.initials: L
authors.lastname: Ma
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.forename: Linfeng
authors.initials: L
authors.lastname: Zhang
authors.forename: Manlu
authors.initials: M
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D000068476:Beijing; D001794:Blood Pressure / Q000187:drug effects; D003151:Community Health Centers; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006852:Hydrochlorothiazide / Q000191:economics / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008790:Metoprolol / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009568:Nitrendipine / Q000191:economics / Q000627:therapeutic use*; D011446:Prospective Studies; D019035:Rural Health Services; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D009568:Nitrendipine; D008790:Metoprolol