Gaps in antihypertensive and statin treatments and benefits of optimisation in an ethnically diverse socio-economically deprived urban UK population
Researchers from the Centres for Evaluation and Methods and Primary Care have worked together on a cross-sectional population study to characterise gaps in blood pressure and statin treatments among people at high cardiovascular disease risk in a large urban UK population, and to quantify the health and economic impacts of treatment optimisation.
Cardiovascular disease is the most common cause of morbidity and mortality worldwide, and hypertension and hypercholesterolaemia are two of its key modifiable risk factors, but widespread suboptimal treatment represents a substantial missed opportunity for disease prevention. In this Barts Charity funded study, data were extracted for adult patients with diagnoses of hypertension or cardiovascular disease among a population of around 1 million people registered with all 123 primary care practices in the City and Hackney, Newham, and Tower Hamlets clinical groups in East London in 2019. The local authorities covered by these NHS services are among the 10% most socially deprived areas in England, and the ethnically diverse population includes large South Asian and Black British, African, and Caribbean ethnic groups. The researchers followed UK clinical guidelines to categorise adults with diagnosed hypertension and diagnosed cardiovascular disease into optimal, suboptimal, and untreated groups with respect to their antihypertensive and statin treatments. Results indicated that 27% of patients with hypertension and 38% of patients with cardiovascular disease do not receive optimal antihypertensive and cholesterol lowering treatments, respectively. A cardiovascular disease model was adapted to project cardiovascular events avoided, years and quality adjusted life years gained, and healthcare costs saved with optimised treatments. Per 1000 additional patients with treatment optimised over five years, hypertension treatment is projected to prevent 25 major vascular events and 7 vascular deaths, and statin treatment would prevent 28 major vascular events and 6 vascular deaths. For patients aged 60-69, the model predicted that for those with uncontrolled hypertension 0.64 quality adjusted life years would be gained with optimised treatment over their lifespan, and for those with previous cardiovascular disease not optimally treated with statins the projected gain would be 0.3 quality adjusted life years with optimised treatment. In both cases, the hospital costs savings minus extra medication costs were about £1100 per person over the remaining lifespan. First author Runguo Wu said: These results show that optimising cardiovascular treatments can cost-effectively reduce cardiovascular risk and improve life expectancy.
Wu R, Rison SCG, Raisi-Estabragh Z, Dostal I, Carvalho C, Robson J, Mihaylova B. Gaps in antihypertensive and statin treatments and benefits of optimisation: a modelling study in a 1 million ethnically diverse urban population in UK. BMJ Open 2021;11:e052884. doi: 10.1136/bmjopen-2021-052884