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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Antihypertensive drugs: a perspective on the value of improved blood pressure control in the USA

Genia Long1,*, David M. Cutler2 and Ernst R. Berndt3

1 Analysis Group, Inc., 111 Huntington Avenue, 10th Floor, Boston, MA 02199, USA
2 Department of Economics, Littauer Center, Harvard University, 1875 Cambridge Street, Cambridge, MA 02138, USA
3 Department of Economics, Sloan School of Management, Massachusetts Institute of Technology, 50 Memorial Drive, E52-452 Cambridge, MA 02142, USA

* E-mail address: glong{at}analysisgroup.com

Aims: We estimated what the improved treatment of high blood pressure with anithypertensive drug therapy has contributed to U.S. public health, in terms of reductions in excess premature deaths from cardiovascular disease, myocardial infarctions, and strokes.

Methods and Results: Using national survey data to estimate blood pressures in the absence of antihypertensive therapy and comparing them with blood pressures actually observed in 1999-00, we inferred the impact of antihypertensive therapy on blood pressure. Using risk equations from the Framingham Heart Study, we estimated the impact of lowered blood pressures on the risk and number of myocardial infarctions and strokes (2002) and deaths (2001). Assigning a monetary value from the literature to the improvement in overall life expectancy related to antihypertensive therapy, we compared it to average spending on antihypertensives.

Conclusion: Antihypertensive therapy has had a major impact on U.S. public health. In the absence of antihypertensives, 1999–00 blood pressures for adults age 40 + would have been 10 to 13 percent higher, and 86000 excess premature deaths from cardiovascular disease (2001), and 833,000 hospital discharges for stroke and myocardial infarction (2002) would have occurred. Treatment has generated a benefit-to-cost ratio of at least 6:1, but much more can be achieved.

Key Words: Hypertension • Myocardial infarction • Stroke • Antihypertensives • Cost-benefit


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