New 2017 ACC/AHA Hypertension Guidelines—Cost-Effectiveness among U.S. Adults with Type 2 Diabetes

Introduction: The new 2017 American College of Cardiology (ACC) and American Heart Association (AHA) hypertension guideline defines hypertension as either systolic blood pressure (SBP) > 130 mmHg or diastolic blood pressure (DBP) > 80 mmHg, compared with the old guideline of SBP >140 mmHg or DBP > 90 mmHg. The new definition would increase number of persons eligible for hypertension treatment. Our objectives were to estimate how many more persons with type 2 diabetes would be eligible for hypertension treatment under the new guideline and to assess the cost-effectiveness (CE) of treating this newly eligible population.

Method: Data from the 2011-2016 National Health and Nutrition Examination Survey and the 2015 Census were used to estimate the numbers of persons with diabetes who would be eligible for hypertension treatment under the new and old guidelines. The CDC-RTI cost-effectiveness diabetes simulation model was used to project the lifetime health and cost (2017 USD) consequences of treating newly eligible persons. Two hypertension treatments were modeled: moderate BP treatment as defined in the guidelines and intensive BP treatment using multiple antihypertensive drugs as implemented in the UK Prospective Diabetes Study trial. The CE of the new guideline was measured using costs per quality-adjusted life year (QALY).

Results: The number of persons with diabetes eligible for hypertension treatment would increase from 8.4 (27.7%) to 15.7 million (51.9%) under the new ACC/AHA guideline. Treating hypertension persons defined by new guideline would result in $3038/QALY if the moderate BP treatment were implemented and would be cost-saving if intensive BP treatment were implemented, compared to treating persons defined through old guideline.

Conclusion: The new ACC/AHA hypertension guideline would nearly double the number of persons with diabetes who would be eligible for hypertension treatment. Treating those newly eligible is likely to be cost-effective or even cost-saving.