Background: Results from the recent SPRINT trial demonstrate lower rates of fatal and non-fatal major cardiovascular events and all-cause mortality in non-diabetics at high cardiovascular risk with intensive versus standard treatment, i.e., less than 120 versus less than 140 mmHg systolic, respectively. However, the long-term outcomes remain unknown.
Methods: A validated state-transition model with multivariate risk equations was populated with the baseline characteristics of the SPRINT trial, and cost and health-related quality of life data for the United States. Model projections, based on trial-observed blood pressures, were compared to actual median follow-up trial results for calibration. To assess long-term outcomes, we projected 20-year incidence in myocardial infarctions (MI), strokes, heart failure (HF), and end-stage renal disease (ESRD), and derived relative risks (RR) and numbers needed to treat (NNT). Direct medical costs, discounted at 3% p.a., were computed for both strategies.
Results: The calibrated model outcomes matched the published SPRINT trial results at a median follow-up of 39 months. Over the 20-year horizon, intense blood pressure control was projected to lead to lower incidences of all studied events (see table 1). Life expectancy increased by 2.5 years (85.8 vs. 83.3 years), at similar discounted lifetime costs of about $47K.
Conclusions: Our model-based projections suggest intensive blood pressure control in non-diabetics at high cardiovascular risk is associated with significant long-term benefits. Numbers needed to prevent mortality are particularly attractive. Cost savings seem to be consumed by additional life expectancy. Patient-level data analysis via bootstrapping is necessary to quantify the uncertainty.
Methods: A validated state-transition model with multivariate risk equations was populated with the baseline characteristics of the SPRINT trial, and cost and health-related quality of life data for the United States. Model projections, based on trial-observed blood pressures, were compared to actual median follow-up trial results for calibration. To assess long-term outcomes, we projected 20-year incidence in myocardial infarctions (MI), strokes, heart failure (HF), and end-stage renal disease (ESRD), and derived relative risks (RR) and numbers needed to treat (NNT). Direct medical costs, discounted at 3% p.a., were computed for both strategies.
Results: The calibrated model outcomes matched the published SPRINT trial results at a median follow-up of 39 months. Over the 20-year horizon, intense blood pressure control was projected to lead to lower incidences of all studied events (see table 1). Life expectancy increased by 2.5 years (85.8 vs. 83.3 years), at similar discounted lifetime costs of about $47K.
Conclusions: Our model-based projections suggest intensive blood pressure control in non-diabetics at high cardiovascular risk is associated with significant long-term benefits. Numbers needed to prevent mortality are particularly attractive. Cost savings seem to be consumed by additional life expectancy. Patient-level data analysis via bootstrapping is necessary to quantify the uncertainty.
| intensive | standard | RR | NNT | |
| MI | 17.9% | 18.6% | 0.96 | 140 |
| Stroke | 17.7% | 18.4% | 0.96 | 146 |
| HF | 5.6% | 5.8% | 0.98 | 696 |
| ESRD | 3.6% | 4.4% | 0.82 | 127 |
| CV death | 54.1% | 57.8% | 0.94 | 27 |
| All-cause death | 64.4% | 73.1% | 0.88 | 11 |