P-332: Treatment of mild hypertension: is it worthwhile?

• Published in: American journal of hypertension 2003-05, Vol.16 (S1), p.156A-157A
• Main Authors: Lewis, Andrea K., Jackson, Peter R.
• Format: Article
• Language: English
• Subjects: decision analysis; drug treatment of hypertension; utility
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/S0895-7061(03)00497-7

Guidelines1,2 for the management of mild hypertension advise drug treatment for all with elevated coronary heart disease (CHD) risk. In contrast population surveys3,4 suggest the majority would not wish drug treatment unless it offered a benefit greater than that seen in intervention trials. We try to reconcile these views using a model based on decision analysis. We used a model with utility weighted according to time spent in each health state. States considered were:- healthy, healthy but having to take tablets, major and minor stroke, angina, heart failure and death. Utility values attributed to each state were derived from telephone standard gamble interviews of 125 randomly selected members of the public. Likelihood of each health state related to CHD risk and relative benefit from drug treatment were derived from controlled clinical trials in mild hypertension. The model was used to determine that CHD risk at which cumulative utility favoured drug therapy for patients requiring 1, 2 or 3 drugs for blood pressure control. Utility of drug treatment for mild hypertension only exceeds that of non-treatment when CHD risk > 18% over 10 years and then only if controlled with a single agent. Utility associated with drug treatment is the major determinant of the CHD risk at which drug treatment provides greater cumulative utility. Many find drug treatment little burden and may benefit from treatment at lower risk. Rational decision analysis does not reflect the usual decision making process for doctors or patients. Its use with patients may increase satisfaction but has not yet been shown to improve compliance. It is however a means of determining the level of CHD risk at which patients should be offered treatment. Doctors should understand that rejection of treatment by patients needing several drugs for control or with a strong dislike for drugs may be rational.