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Zhou Y, Chen S, Chen J, Chen S, Wang G, Pan X, Wu S, Pan A. Cost-Effectiveness of a Workplace-Based Hypertension Management Program in Real-World Practice in the Kailuan Study. J Am Heart Assoc 2024; 13:e031578. [PMID: 38563379 PMCID: PMC11262526 DOI: 10.1161/jaha.123.031578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In 2009, a workplace-based hypertension management program was launched among men with hypertension in the Kailuan study. This program involved monitoring blood pressure semimonthly, providing free antihypertensive medications, and offering personalized health consultations. However, the cost-effectiveness of this program remains unclear. METHODS AND RESULTS This analysis included 12 240 participants, with 6120 in each of the management and control groups. Using a microsimulation model derived from 10-year follow-up data, we estimated costs, quality-adjusted life years (QALYs), life-years, and incremental cost-effectiveness ratios (ICERs) for workplace-based management compared with routine care in both the study period and over a lifetime. Analyses are conducted from the societal perspective. Over the 10-year follow-up, patients in the management group experienced an average gain of 0.06 QALYs with associated incremental costs of $633.17 (4366.85 RMB). Projecting over a lifetime, the management group was estimated to increase by 0.88 QALYs or 0.92 life-years compared with the control group, with an incremental cost of $1638.64 (11 301.37 RMB). This results in an incremental cost-effectiveness ratio of $1855.47 per QALY gained and $1780.27 per life-year gained, respectively, when comparing workplace-based management with routine care. In probabilistic sensitivity analyses, with a threshold willingness-to-pay of $30 765 per QALY (3 times 2019 gross domestic product per capita), the management group showed a 100% likelihood of being cost-effective in 10 000 samples. CONCLUSIONS Workplace-based management, compared with routine care for Chinese men with hypertension, could be cost-effective both during the study period and over a lifetime, and might be considered in working populations in China and elsewhere.
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Affiliation(s)
- Yan‐Feng Zhou
- Department of Social Medicine, School of Public HealthGuangxi Medical UniversityNanningChina
| | - Shuohua Chen
- Department of Cardiology, Kailuan General HospitalNorth China University of Science and TechnologyTangshanChina
| | - Jun‐Xiang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Simiao Chen
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Heidelberg Institute of Global Health, Faculty of Medicine and University HospitalHeidelberg UniversityHeidelbergGermany
| | - Guodong Wang
- Department of Cardiology, Kailuan General HospitalNorth China University of Science and TechnologyTangshanChina
| | - Xiong‐Fei Pan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan UniversityShuangliu Institute of Women’s and Children’s Health, Shuangliu Maternal and Child Health HospitalChengduChina
| | - Shouling Wu
- Department of Cardiology, Kailuan General HospitalNorth China University of Science and TechnologyTangshanChina
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Li X, Chang P, Wu M, Jiang Y, Gao Y, Chen H, Tao L, Wei D, Yang X, Xiong X, Yang Y, Pan X, Zhao R, Yang F, Sun J, Yang S, Tian L, He X, Wang E, Yang Y, Xing Y. Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2354937. [PMID: 38335001 PMCID: PMC10858403 DOI: 10.1001/jamanetworkopen.2023.54937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
Importance Prehypertension increases the risk of developing hypertension and other cardiovascular diseases. Early and effective intervention for patients with prehypertension is highly important. Objective To assess the efficacy of Tai Chi vs aerobic exercise in patients with prehypertension. Design, Setting, and Participants This prospective, single-blinded randomized clinical trial was conducted between July 25, 2019, and January 24, 2022, at 2 tertiary public hospitals in China. Participants included 342 adults aged 18 to 65 years with prehypertension, defined as systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic BP (DBP) of 80 to 89 mm Hg. Interventions Participants were randomized in a 1:1 ratio to a Tai Chi group (n = 173) or an aerobic exercise group (n = 169). Both groups performed four 60-minute supervised sessions per week for 12 months. Main Outcomes and Measures The primary outcome was SBP at 12 months obtained in the office setting. Secondary outcomes included SBP at 6 months and DBP at 6 and 12 months obtained in the office setting and 24-hour ambulatory BP at 12 months. Results Of the 1189 patients screened, 342 (mean [SD] age, 49.3 [11.9] years; 166 men [48.5%] and 176 women [51.5%]) were randomized to 1 of 2 intervention groups: 173 to Tai Chi and 169 to aerobic exercise. At 12 months, the change in office SBP was significantly different between groups by -2.40 (95% CI, -4.39 to -0.41) mm Hg (P = .02), with a mean (SD) change of -7.01 (10.12) mm Hg in the Tai Chi group vs -4.61 (8.47) mm Hg in the aerobic exercise group. The analysis of office SBP at 6 months yielded similar results (-2.31 [95% CI, -3.94 to -0.67] mm Hg; P = .006). Additionally, 24-hour ambulatory SBP (-2.16 [95% CI, -3.84 to -0.47] mm Hg; P = .01) and nighttime ambulatory SBP (-4.08 [95% CI, -6.59 to -1.57] mm Hg; P = .002) were significantly reduced in the Tai Chi group compared with the aerobic exercise group. Conclusions and Relevance In this study including patients with prehypertension, a 12-month Tai Chi intervention was more effective than aerobic exercise in reducing SBP. These findings suggest that Tai Chi may help promote the prevention of cardiovascular disease in populations with prehypertension. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR1900024368.
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Affiliation(s)
- Xinye Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Peifen Chang
- Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Min Wu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Yuchen Jiang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Yonghong Gao
- Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | - Hengwen Chen
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Liyuan Tao
- Clinical Epidemiology Research Center of the Third Hospital of Peking University, Beijing, China
| | - Dawei Wei
- Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaochen Yang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Xingjiang Xiong
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Yan Yang
- Vasculocardiology Department, Fuzhou Hospital of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiandu Pan
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Ran Zhao
- YongDingLu Community Health Care Center, Aerospace Center Hospital, Beijing, China
| | - Fan Yang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Jiahao Sun
- Traditional Chinese Medicine Department, BaiLi Traditional Chinese Medicine Clinic, Beijing
| | - Shengjie Yang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Li Tian
- Medical Department of Beijing Gulou Traditional Chinese Medicine Hospital, Beijing, China
| | - Xiaofang He
- Cardiovascular Department of Affiliated Hospital of Shanxi University of Chinese Medicine, Taiyuan, China
| | - Eryu Wang
- Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yiyuan Yang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Yanwei Xing
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
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Li J, Zhao D, Cai J, Chen S, Wu S, Qi Y. Cost-effectiveness of treatment in adults with blood pressure of 130-139/80-89 mmHg and high cardiovascular risk in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100962. [PMID: 38045985 PMCID: PMC10689267 DOI: 10.1016/j.lanwpc.2023.100962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023]
Abstract
Background The most recent updated hypertension guidelines recommend individuals with systolic blood pressure (SBP)/diastolic blood pressure (DBP) of 130-139/80-89 mmHg and high cardiovascular risk should receive antihypertensive drug treatment. This study aimed to assess the benefits and cost-effectiveness of medication for people aged ≥35 years with this blood pressure stratum and high cardiovascular risk in China. Methods The benefits of drug treatment in adults aged ≥35 years with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk were evaluated in decision-analytic simulation models. Decreasing numbers of cardiovascular disease (CVD) events and premature deaths from all causes and increasing quality-adjusted life-years (QALYs) from drug treatment were estimated in 10-year and lifetime horizons. The incremental cost-effectiveness ratios (ICER) for drug treatment were calculated. Findings Among approximately 106.60 million Chinese adults aged ≥35 years with this blood pressure stratum and high cardiovascular risk, drug treatment was estimated to prevent 2,060,000 strokes and 660,000 myocardial infarctions over a 10-year time horizon. Adults prescribed antihypertensive drugs could gain 0.034 incremental QALYs. Over a lifetime horizon, adults who start treatment earlier could benefit more in preventing CVD and gaining incremental QALYs. The medication treatment is cost-effective either over a 10-year time horizon with an ICER of Int$13321.29 per QALY gained or over the remaining lifetime. Interpretation Antihypertensive treatment of adults with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk would gain substantial benefits with cost-effectiveness. The young and middle-aged population would derive the most benefit. Funding National Natural Science Foundation of China, and Beijing Natural Science Foundation.
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Affiliation(s)
- Jiangtao Li
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Dong Zhao
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Rd. 167, Xicheng District, Beijing 100037, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, 57 Xinhua East Rd, Tangshan 063000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, 57 Xinhua East Rd, Tangshan 063000, China
| | - Yue Qi
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
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Zhou YF, Deng H, Wang GD, Chen S, Xing A, Wang Y, Zhao H, Gao J, Wu S. Cost-effectiveness of drug treatment for young and middle-aged stage 1 hypertensive patients with high risk. J Glob Health 2023; 13:04147. [PMID: 37997845 PMCID: PMC10668205 DOI: 10.7189/jogh.13.04147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Background Drug treatment was recommended for stage 1 hypertensive patients (blood pressure of 130-139 / 80-89 millimetres of mercury (mmHg)) with high cardiovascular disease (CVD) risk in the 2017 Hypertension Clinical Practice Guidelines, 2018 Chinese guidelines and 2021 World Health Organization guidelines, but not in other guidelines. However, evidence on the cost-effectiveness of drug treatment among young and middle-aged patients remains scarce. This study aimed to compare the cost-effectiveness of drug treatment vs. non-drug treatment for stage 1 hypertensive patients aged <60 years with high CVD risk. Methods A microsimulation model projected quality-adjusted life years (QALYs), health care costs, and incremental cost-effectiveness ratios for drug treatment from a societal perspective. Transition probabilities were estimated from the Kailuan study with a sample size of 34 093 patients aged <60 years with high CVD risk. Costs and health utilities were obtained from the Kailuan study, national statistics reports and published literature. Results Over a 15-year time horizon, the model predicted that drug treatment generated QALY of 9.36 and was associated with expected costs of 3735 US dollars ($) compared with 9.07 and $3923 produced by non-drug treatment among stage 1 hypertensive patients, resulting in a cost-saving for drug treatment. At a willingness-to-pay threshold of $10439/QALY (one gross domestic product (GDP) per capita in 2020), drug treatment had a 99.99% probability of being cost-effective for 10 000 samples of probabilistic sensitivity analysis. Sensitivity analyses by different values of transition probability, cost, utility and discount rate did not appreciably change the results. Shortening the time horizon to the average follow-up period of eight years resulted in ICER of $189/QALY for drug treatment (<1 × GDP/QALY). Conclusions Our results suggested that drug treatment was a dominant strategy for stage 1 hypertensive patients aged <60 years with high CVD risk in China, which may provide evidence for policymakers and clinicians when weighing the pros and cons of drug treatment for young and middle-aged stage 1 hypertensive patients.
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Affiliation(s)
- Yan-Feng Zhou
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China
| | - Hua Deng
- Department of Nephrology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Guo-Dong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Aijun Xing
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yanxiu Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Haiyan Zhao
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jingli Gao
- Department of Intensive Care Unit, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
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Liang L, Shao T, Li H, Zhao M, Tang W. Cost-effectiveness and potential budget impact of non-pharmacological interventions for early management in prehypertensive people: an economic evaluation for China. BMC Public Health 2023; 23:1531. [PMID: 37568086 PMCID: PMC10416408 DOI: 10.1186/s12889-023-16458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Non-pharmacological interventions (NPIs) could be considered in the early management of prehypertensive population. This study aimed to evaluate the potential cost-effectiveness of NPIs and the budget impact of implementing NPIs on prehypertensive population in China and provide evidence of chronic disease management innovation for decision-makers. METHODS Five NPIs including usual care, lifestyle, strengthen exercise, relaxation, and diet therapy were selected based on the practice of hypertension management in China. A nine-state Markov model was constructed to evaluate the lifetime costs and health outcomes of five NPIs and a non-intervention group from the perspective of Chinese healthcare system. The effectiveness of NPIs was obtained from a published study. Parameters including transition probabilities, costs and utilities were extracted or calculated from published literature and open-access databases. Sensitivity analyses were conducted to test the uncertainty of all parameters. The impact of duration of intervention was considered in scenario analyses. A budget impact analysis (BIA) was conducted to evaluate the total cost and the medical cost saving of a hypothetical nationwide implementation of potential cost-effective NPI in prehypertensive people. Management strategies including focusing on patients with specific ages or different CVE risk levels, and different duration of implementation were taken into consideration. RESULTS Strengthen exercise was the most cost-effective intervention with a probability of 78.1% under the given WTP threshold. Our results were sensitive to the cost of interventions, and the utility of prehypertension and hypertension. The duration of implementation had limited impact on the results. BIA results showed that the program cost was hefty and far more than the medical cost saving with the course of simulation time. Applying management strategies which focused on individual characteristics could largely reduce the program cost despite it remained higher than medical cost saving. CONCLUSIONS Strengthen exercise was a potential NPI that can be considered in priority for early management in prehypertensive population. Although early management can acquire medical cost saving, the related program cost can be quite hefty. Precise strategies which may help reduce the cost of early management should be taken into consideration in program design.
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Affiliation(s)
- Leyi Liang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Taihang Shao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Hao Li
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Mingye Zhao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Wenxi Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
- Department of Public Affairs Management, School of International Pharmaceutical Business, Pharmaceutical University, 211198, Nanjing, China.
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Shao T, Liang L, Zhou C, Tang Y, Gao W, Tu Y, Yin Y, Malone DC, Tang W. Short-term efficacy of non-pharmacological interventions for global population with elevated blood pressure: A network meta-analysis. Front Public Health 2023; 10:1051581. [PMID: 36711409 PMCID: PMC9880179 DOI: 10.3389/fpubh.2022.1051581] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background This study aims to compare the potential short-term effects of non-pharmacological interventions (NPIs) on prehypertensive people, and provide evidence for intervention models with potential in future community-based management. Methods In this Bayesian network meta-analysis, Pubmed, Embase, and Web of science were screened up to 16 October 2021. Prehypertensive patients (systolic blood pressure, SBP 120-139 mmHg/diastolic blood pressure, DBP 80-89 mmHg) with a follow-up period longer than 4 weeks were targeted. Sixteen NPIs were identified during the scope review and categorized into five groups. Reduction in SBP and DBP was selected as outcome variables and the effect sizes were compared using consistency models among interventions and intervention groups. Grade approach was used to assess the certainty of evidence. Results Thirty-nine studies with 8,279 participants were included. For SBP, strengthen exercises were the most advantageous intervention group when compared with usual care (mean difference = -6.02 mmHg, 95% CI -8.16 to -3.87), and combination exercise, isometric exercise, and aerobic exercise were the three most effective specific interventions. For DBP, relaxation was the most advantageous intervention group when compared with usual care (mean difference = -4.99 mmHg, 95% CI -7.03 to -2.96), and acupuncture, meditation, and combination exercise were the three most effective specific interventions. No inconsistency was found between indirect and direct evidence. However, heterogeneity was detected in some studies. Conclusion NPIs can bring short-term BP reduction benefits for prehypertensive patients, especially exercise and relaxation. NPIs could potentially be included in community-based disease management for prehypertensive population once long-term real-world effectiveness and cost-effectiveness are proven. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151518, identifier: CRD42020151518.
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Affiliation(s)
- Taihang Shao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Leyi Liang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yaqian Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Wenqing Gao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Yusi Tu
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Yue Yin
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Daniel C. Malone
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States,Daniel C. Malone ✉
| | - Wenxi Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China,Department of Public Affairs Management, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China,*Correspondence: Wenxi Tang ✉
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Li B, Cao H, Liu K, Xia J, Sun Y, Peng W, Xie Y, Guo C, Liu X, Wen F, Zhang F, Shan G, Zhang L. Associations of long-term ambient air pollution and traffic-related pollution with blood pressure and hypertension defined by the different guidelines worldwide: the CHCN-BTH study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:63057-63070. [PMID: 35449329 DOI: 10.1007/s11356-022-20227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
The assessment of the generalization of the strict hypertension definition in the 2017 ACC/AHA Hypertension Guideline from environmental condition remains sparse. The aims of this study are to investigate and compare the associations of ambient air pollution and traffic-related pollution (TRP) with hypertension defined by the different criteria. A total of 32,135 participants were recruited from the baseline survey of the CHCN-BTH in 2017. We defined hypertension as SBP/DBP ≥ 140/90 mmHg according to the hypertension guidelines in China, Japan, Europe and ISH (traditional criteria) and defined as SBP/DBP ≥ 130/80 mmHg according to the 2017 ACC/AHA Hypertension Guideline (strict criteria). A two-level generalized linear mixed models were applied to investigate the associations of air pollutants (i.e. PM2.5, SO2, NO2) and TRP with blood pressure (BP) measures and hypertension. Stratified analyses and two-pollutant models were also performed. The stronger associations of air pollutants were found in the hypertension defined by the strict criteria than that defined by the traditional criteria. The ORs per an IQR increase in PM2.5 were 1.17 (95% CI: 1.09, 1.25) for the strict criteria and 1.14 (95% CI: 1.06, 1.23) for the traditional criteria. The similar conditions were also observed for TRP. The above results were robust in both stratified analyses and two-pollutant models. Our study assessed the significance of the hypertension defined by the strict criteria from environmental aspect and called attention to the more adverse effects of air pollution and TRP on the earlier stage of hypertension.
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Affiliation(s)
- Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Kuo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Juan Xia
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Fengxu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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Lou Y, Yu Y, Liu J, Huang J. Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials. Front Public Health 2022; 10:959139. [PMID: 36062091 PMCID: PMC9432800 DOI: 10.3389/fpubh.2022.959139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Background Sacubitril-valsartan was recommended for heart failure (HF) and proven cost-effective in HF. Recently, sacubitril-valsartan has been recommended to treat hypertension by the Chinese expert consensus. The cost utility of sacubitril-valsartan for hypertension remains uninvestigated. Methods A meta-analysis of randomized controlled trials (RCTs) was performed to investigate the real efficacy of sacubitril-valsartan on blood pressure, compared with angiotensin receptor blockers or placebo. A lifetime Markov model was developed to compare the cost utility of sacubitril-valsartan vs. valsartan. The primary outcome was the incremental cost-utility ratio (ICUR), representing the ratio of incremental costs to the incremental utility. The willingness-to-pay (WTP) threshold was three times of per capita gross domestic product (GDP) in China in 2021. Sacubitril-valsartan was considered cost-effective if the ICUR obtained was lower than the WTP threshold, otherwise, sacubitril-valsartanis was not cost-effective. Results A total of 10 RCTs of 5,781 patients were included in the meta-analysis. For comparison of sacubitril-valsartan 400 mg/day vs. valsartan 320 mg/day, a reduction in blood pressure (BP) of -5.97 (-6.38, -5.56) (p < 0.01) was observed. Cost-utility analysis showed that for a 60-year-old patient with hypertension, if sacubitril-valsartan was prescribed as the antihypertensive agent, he had a life expectancy of 11.91 quality-adjusted life-years (QALYs) with costs of 65,066 CNY, and if valsartan was prescribed as the antihypertensive agent, the life expectancy would be 11.82 QALY with costs of 54,769 CNY; thus, an ICUR of 108,622 CNY/QALY was obtained, lower than the WTP threshold. Conclusion Compared with valsartan, sacubitril-valsartan is more effective in reducing blood pressure and may result in more quality-adjusted life-year, although with higher costs. Sacubitril-valsartan is cost-effective for hypertension in the current China setting under the willingness-to-pay threshold of 3 times of per capita GDP.
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Affiliation(s)
- Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxing Liu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang J, Liu J, Teng H, Zhang Y, Dong X, Chen W, Yin J. Blood pressure categories defined by the 2017 ACC/AHA guideline and all-cause mortality: a national cohort study in China and meta-analysis. J Hum Hypertens 2022; 36:95-105. [PMID: 33589762 DOI: 10.1038/s41371-021-00495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 01/31/2023]
Abstract
The 2017 American College of Cardiology/American Heart Association guideline recommends a lowered threshold for hypertension diagnosis. Nonetheless, the association of blood pressure (BP) groups defined by the new guideline and all-cause mortality has not been fully estimated, especially in general Chinese. Based on the China Health and Retirement Longitudinal Study (CHARLS) during 2011-2018, 12,964 participants aged 45 years or older at baseline were enrolled for a follow-up of 7 years. Cox proportional hazards models were used to examine the relationship of BP classifications with all-cause mortality, with normal BP (<120/80 mmHg) as a reference. Afterwards, eligible studies shed light in this field were searched in public databases, and meta-analysis was conducted. In CHARLS, there were 41.21% and 16.08% individuals with stage 2 hypertension and stage 1 hypertension, respectively. During the follow-up, 1293 death occurred. The redefined stage 1 (130-139/80-89 mmHg) and stage 2 hypertension (≥140/≥90 mmHg) were found to have increased risk of death in the crude model, but only stage 2 hypertension maintained statistically significance after adjustment. Furthermore, meta-analysis including CHARLS and nine other prospective studies, with a total of 290,609 participants followed up for 3,081,532 person-years, resulted in similar results (combined hazard ratio (95% confidence interval) was 1.07 (0.99-1.15) for stage 1 hypertension, and 1.39 (1.25-1.53) for stage 2 hypertension). The present study detected that individuals with stage 2 and stage 1 hypertension had increased likelihood to die from any cause, but only the former association achieved statistically significance. Further cohorts with long-term follow-up duration are warranted, especially in China.
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Affiliation(s)
- Jiaxiang Wang
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jieyu Liu
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Haoyue Teng
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yushan Zhang
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Xingxuan Dong
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Wei Chen
- Zhuhai Center for Chronic Disease Control, Zhuhai, Guangdong, China.
| | - Jieyun Yin
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China.
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Liu S, Yuan H, Jiang C, Xu J, Qiu X, Luo J. The blood pressure control and arteriosclerotic cardiovascular risk among Chinese community hypertensive patients. Sci Rep 2021; 11:19066. [PMID: 34561523 PMCID: PMC8463712 DOI: 10.1038/s41598-021-98745-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 12/04/2022] Open
Abstract
The present study aimed to describe the blood pressure (BP) control rate and 10-years arteriosclerotic cardiovascular disease (ASCVD) risk estimation among community hypertensive patients. A total of 196,803 subjects were enrolled. The control rates calculated as the intensive (SBP < 130 mmHg and DBP < 80 mmHg) and standard (SBP < 140 mmHg and DBP < 90 mmHg) threshold. Multivariable logistic analysis was employed to assess the associations between cardiovascular factors and BP control. Sensitivity, specificity and Youden’s index were used to identify the ability of high risk of ASCVD estimation by different thresholds. The control rate was 16.34% and 50.25% by the intensive and standard threshold, respectively. Besides regular medication, the risk factors for BP control included older age, male, unhealthy lifestyle, obesity, dyslipidemia and abnormal FPG. 25.08% of subjects had high risk of 10-years ASCVD estimation. The sensitivity, specificity and Youden’s index of intensive threshold was 84.37%, 16.15% and 0.51%, and were significantly different from 50.55%, 50.42% and 0.98% of the standard threshold, respectively. Half of community hypertensive patients did not control BP, and nearly a quarter have high risk of 10-years ASCVD risk estimation. The intensive threshold resulted in a one-third reduction in the control rate compared to the standard threshold. No matter which threshold was used, a single BP control status seemed not a suitable indicator for identification of high risk of 10-years ASCVD risk estimation.
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Affiliation(s)
- Shijun Liu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China.
| | - Hanyan Yuan
- Gongshu District Center for Disease Control and Prevention, Hangzhou, China
| | - Caixia Jiang
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Jue Xu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Xin Qiu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Jun Luo
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
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Li N, Huang J, Zheng B, Cai H, Liu M, Liu L. Cost-effectiveness analysis of screening for primary aldosteronism in China. Clin Endocrinol (Oxf) 2021; 95:414-422. [PMID: 33837588 DOI: 10.1111/cen.14478] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primary aldosteronism (PA) is an underdiagnosed cause of hypertension. Although the medical costs will increase if all patients with elevated blood pressure are screened, the number of missed diagnosed patients with PA and the medical resources subsequently consumed by adverse cardiovascular and cerebrovascular events can be reduced. This study aimed to conduct economic evaluation PA screening strategies in Chinese patients with hypertension, that is PA screening in patients with high-risk hypertension and all patients with hypertension, to determine the cost-effective method. METHODS The decision tree and Markov model were constructed using TreeAge Pro 2020. Using the latter, a 30-year course of hypertension after different screening strategies was simulated, with a cycle of one year. The model parameters included epidemiological data, clinical efficacy, cost and effectiveness. The total cost of treatment and quality-adjusted life year (QALY) were simulated to conduct a cost-effectiveness analysis. Univariate and probabilistic sensitivity analyses of the model were also performed. RESULTS PA screening patients with high-risk hypertension and all patients with hypertension obtained 15.75 and 15.77 QALYs and the costs were $2488.39 and $2482.15, respectively. The strategy of PA screening in all patients with hypertension is cost-saving and produces more health outcomes. The sensitivity analysis showed that the results were reliable. CONCLUSION From the perspective of China's health system, the strategy of screening all hypertensive patients for PA may be more cost-effective than screening only high-risk patients and providing standard antihypertensive treatment for low-risk hypertensive patients.
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Affiliation(s)
- Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jingze Huang
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Hongfu Cai
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Libin Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
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