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A Closer Look at High Blood Pressure | Hypertension | Pharmaceutical Drug

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Roughly 50 million Americans ages six and older have high blood pressure. Left untreated, high blood pressure can lead to heart disease, kidney disease, and stroke. In this six-page brochure, a joint project between the American Heart Association and NPC, we take a closer look at the factors influencing drug spending for the treatment of high blood pressure.
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  A  JOINTPROJECTBETWEEN T HE A MERICAN H EART A SSOCIATIONAND T HE N ATIONAL P HARMACEUTICAL C OUNCIL A C LOSER L OOKAT Nearly one in four Americans has highblood pressure.  H igh blood pressure is a silent killer responsible for thedeaths of more than 44,000 Americans in 1998. Dataindicate that the death rate associated with high bloodpressure is rising. Two types of bloodpressure—systolic and diastolic—aremeasured. High blood pressure, orhypertension, is defined in an adult as asystolic pressure of 140 millimeters of mercury (mm Hg) or higher and/or adiastolic pressure of 90 mm Hg or higher(see box on next page). 1 High blood pressure can occur inchildren or adults, but is particularlyprevalent in African-Americans,middle-aged and elderly people, obesepeople, heavy drinkers, and womentaking oral contraceptives. People withdiabetes, gout, or kidney disease have ahigher frequency of high bloodpressure. 2 Roughly 50 millionAmericans age six and older have highblood pressure. 3 Left untreated, highblood pressure can lead to heartdisease, kidney disease, and stroke. 3 In2001, the estimated total direct costs of treating high blood pressure areestimated at $29.6 billion, in addition to$10.8 billion in indirect costs from lostproductivity. 3 Many people have undiagnosed high blood pressurebecause the symptoms are not always obvious. It isestimated that only 68 percent of Americans with highblood pressure are aware of their condition. While four-fifths of those diagnosed with high blood pressure takemedication for it, only half of those patients actually controltheir blood pressure adequately. This failure to control highblood pressure may be due to improper treatment,noncompliance with prescribed medications and lifestylechanges, or other reasons. 1 High blood pressure is primarily treated through lifestylemodification and drug therapy. Patients may be advised tostop smoking, lose weight, exercise regularly, and limit theirintake of salt, fats, and alcohol. 1 Studies have found that bodyweight, changes in body weight over time, and skinfoldthickness are related to changes in blood pressure levels.These factors have been linked to the later rise anddevelopment of high blood pressure. People who areoverweight are more likely to have high-normal to mild-highblood pressure. Most Americans also consume far more saltthan their bodies need. Heavy sodium consumptionincreases blood pressure in some people, leading to highblood pressure. The American Heart Association NutritionCommittee recommends a diet low in salt and fat, and rich inpotassium, calcium, magnesium and protein. 4 The Sixth Report of the Joint National Committee onPrevention, Detection, Evaluation, and Treatment of Hypertension (JNC), published in 1997, contains practiceguidelines for treatment of high blood pressure. 1 Theguidelines state that patients with mild or moderate highblood pressure should begin treatment with long-acting, once-daily drug therapy. Patients with severe high blood pressuremay require a more aggressive medication regimen. If theinitial therapy fails, a drug from a different therapeutic class orcombination therapy should be prescribed.There are several classes of medications used to treat highblood pressure and each reduces blood pressure through adifferent mechanism. Diuretics rid the body of excess fluidsand salt; beta blockers reduce heart rate and the heart’soutput of blood; sympathetic nerve inhibitors preventnerves from constricting blood vessels; vasodilators relaxthe muscles in the walls of blood vessels; ACE inhibitors andangiotensin II receptor blockers affect the body’sproduction and absorption of angiotensin, a chemical thatcauses arteries to constrict; and calcium channel blockersreduce heart rate and relax blood vessels. 5 These drugs arealso used to treat people with heart problems, glaucoma,kidney disease, and other conditions. Currently no class of drugs is accepted to be most effective for treating highblood pressure. Combinations of existing drugs are oftenmore effective than single-drug therapy. 6, 7 Studies haveshown that among patients with high blood pressure,maintaining a healthy blood pressure requires the use of multiple drugs in most cases. 8, 9 A number of studies have highlighted the health benefits of lowering high blood pressure even by small amounts.Analyses of recent clinical trials indicate a 38 percent decreasein strokes among patients who lowered their blood pressureonly slightly. 10 More recent studies point to a 16 percentreduction in heart disease-related deaths for individualsundergoing long-term drug therapy for high blood pressure. 10 Treating high blood pressure long-term has been shown tolower health care costs and to reduce rates of related diseasesand death. According to one study, when the number of patients controlling high blood pressure increased from 44 to68 percent, annual health care costs dropped by 40 percent. 11  Blood pressure (mm Hg) Systolic (top number)Diastolic (bottom number) Optimal Less than 120Less than 80 Normal Less than 130Less than 85 High Normal 130-13985-89 Hypertension 140 or higher90 or higher T here is some concern that the prescription of drugs may not always follow the JNCguidelines. This could, in some cases, be due to poor compliance and othermedical conditions. High blood pressure treatment compliance appears to beclosely tied to the side-effect profiles of drugs and cost concerns. In general, as theside-effect profile of a medication worsens, so does treatment compliance. 12 Physiciansmay also deviate from standard guidelines to accommodate other medical conditions.Certain drugs, for instance, can aid people with Type I diabetes by decreasing theirresistance to insulin. 13 In the face of rising prevalence, meeting national treatment goals may requirecoordinated efforts to raise awareness, encourage treatment, and achieve control of high blood pressure. Education programs can alert the public to the need for bloodpressure testing and highlight the health benefits of controlling hypertension. Newmedications can also play a role. Together, new therapies and better practicepatterns are the keys to improving high blood pressure control. T OTAL DIRECT COSTS OF TREATING HYPERTENSION AREESTIMATED TO BE  $29.6 BILLION IN  2001.F  ACTORS THAT INCREASE YOUR RISK OF DEVELOPINGHIGH BLOOD PRESSURE : ã  Family history of high blood pressure ã  Race (African-Americans are more likely to have high blood pressure than Caucasians.) ã  Male gender (Men have a greater risk of high blood pressure than women until age 55, when their respective risks aresimilar. At age 75 and older, women are more likely to develop high blood pressure than men.) ã  Age (Blood pressure tends to increase with age.) ã  Sensitivity to salt ã  Obesity and excess weight ã  Heavy alcohol consumption ã  Use of oral contraceptives and some other medications ã  Sedentary or inactive lifestyleSource: American Heart Association. (2001) Heart and Stroke A-Z Guide: High Blood Pressure, Factors that Contribute to.[Online]. Available: http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/hbpf.html [10/18/01]. B LOOD  P RESSURE  D EFINED  Spending on pharmaceuticals was analyzed for individuals who received health benefitcoverage from large employers in 1994 and 1997. The sample included individuals whoreceived drug treatment for high blood pressure and those who were diagnosed with acondition other than high blood pressure for which these drugs are often prescribed.Spending for high blood pressure drugs rose 10 percent from 1994 to 1997. Volume factors(increased numbers of people with high cholesterol receiving cholesterol loweringprescriptions, and increased intensity and duration of drug therapy) far outweighed pricefactors, which had a negative impact on spending growth. -1005101520-5 F  ACTORS  I NFLUENCING  D RUG  S PENDING FOR  H IGH  B LOOD  P RESSURE  1994-1997 Volume FactorsPrice Factors Factors Influencing Growth in Rx Expenditures: % Positive Impact % Negative Impact Total Growth in Expenditures +10 Growth Due to Volume Factors +18 Changes in the Number of Prescriptions per Person for Established Drugs-5Changes in the Number of Prescriptions per Person for New Entrants +18Changes in Days of Therapy for Established Drugs +9 Changes in Days of Therapy for New Entrants 0Patients per 1000 Health Care Enrollees-3 Growth Due to Price Factors -8 Inflation +1Changes in Mix of Established Drugs -7Price of New Entrants -2 M ETHODOLOGY  This study separatelyanalyzed prescription drugspending growth for twolarge national claimsdatabases, one representingmanaged care plan enrolleesand the other representingthose covered by largeemployer-provided healthbenefit plans. The studydefined and assessedseveral factors affecting theprice per day of therapy andthe volume of therapy — the number of days of therapy received and thenumber of patients receivingdrug therapy. The analysisalso examined the effects of price and volume changesfor established drugs on themarket during the entireperiod of analysis and fornew drugs that were firstmarketed during this period.Source: MEDSTAT ’ s Marketscan database
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