The disease pathway of hypertension was constructed to reflect the natural history of hypertension and the relationship with CVDs and death. In Tran et al’s study, a Markov model consisted of six health states: well, unstable angina (UA), MI, HF, stroke and death[246]. All patients without previous CVD history were assumed to transit from the well state to one of CVDs or death every year. Transition probabilities from the well state to a CV event or death were estimated using Framingham equations. Once a patient experienced CVD, the annual risks of subsequent events were affected by the previous disease history.
NICE’s model included an additional state of DM to the disease pathway defined in Tran et al’s model[63, 223]. A cohort of patients, initially in the event-free health state, was assumed to move to one of the other defined health states (i.e., MI, UA, stroke, DM, HF or death) or to stay at the event-free health state every six months. The transition probabilities obtained from clinical trials were adjusted for each subgroup by age, gender, ethnicity, baseline CVD, HF risk and DM risk. Other hypertension-related CVDs, RDs or peripheral vascular diseases were not modelled because of limited data.
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