As a result of antihypertensive treatment, some patients can successfully achieve the treatment goal (and live), fail to achieve the treatment goal (and live) or die due to CVD or a non CVD-related cause. According to the NICE’s clinical guidelines, the treatment goal of antihypertensive drugs is to reduce SBP<140 mmHg for patients whose 10-year CVD risk≥20%, and SBP<160 if 10-year CVD risk<20%”[63]. In the hypertension SDDP model, treatment failure is defined as the patients who either do not achieve the treatment goal recommended by NICE or have a CVD, DM or other AEs. The inclusion of CVD, DM and other AEs were justified as following:
CVDs
Modelled CVDs include UA, MI, stroke and HF. The association between blood pressure and the incidence of stroke and CHD is described in section 4.2.
DM
DM is included to consider the long-term potential impact of diabetics on the cost and clinical effectiveness of antihypertensive drugs. Hypertension is one of the risk factors for the development of DM[259, 260]. Incidence of new-onset DM is 2.5-5 times higher in individuals with elevated blood pressure than normotensive subjects[260-262]. Previous studies have suggested that Ds and BBs may be associated with the development of type 2 DM[261-263]. Some epidemiologic studies and clinical trials also suggested a causal link between the use of Ds or BBs and the development of type 2 DM[264-266]. The reason can be explained by the glucose- and insulin-related negative metabolic effects of Ds[267, 268] and BBs[269-271]. Recently, attention has been moving to the potential metabolic effects of ACEIs and ARBs[272].
Hypertension and DM are independent risk factors for CVDs: patients with both hypertension and DM are particularly vulnerable to CVD. The risk is approximately 2-4 times the CVD risk of the general population[273-275]. While most previous CEAs in primary hypertension excluded the long-term potential impact of DM on the cost and clinical effectiveness of antihypertensive drugs[42, 246, 276], this study includes DM in the model structure to antihypertensive drugs as risk factors for type 2 DM.
