Pharmacoeconomic Benefits of Antihypertensive Therapy

BACKGROUND: Effective blood pressure reduction reduces cardiovascular risk and prevents later complications. OBJECTIVES: To consider the pharmacoeconomic benefits of antihypertensive therapy. SUMMARY: Every managed care pharmacist should consider the balance of cost and benefit of antihypertensive therapies, ensuring that best treatment options for patients with the lowest cost to the health care system are available and implemented. Pharmacists must also evaluate the direct and indirect cost associated with risk reduction for stroke and cardiovascular disease. CONCLUSIONS: Using an interdisciplinary approach to hypertension treatment, pharmacists can assume a major role in detection, management, and control of hypertensive patients. As the medical teams' drug expert, they will be expected to recommend best treatment options for effective blood pressure control and cardiovascular risk reduction.

SUMMARY: Every managed care pharmacist should consider the balance of cost and benefit of antihypertensive therapies, ensuring that best treatment options for patients with the lowest cost to the health care system are available and implemented. Pharmacists must also evaluate the direct and indirect cost associated with risk reduction for stroke and cardiovascular disease.
CONCLUSION: Using an interdisciplinary approach to hypertension treatment, pharmacists can assume a major role in detection, management, and control of hypertensive patients. As the medical teams' drug expert, they will be expected to recommend best treatment options for effective blood pressure control and cardiovascular risk reduction.

Pharmacoeconomic Benefits of Antihypertensive Therapy
Patients often believe that any asymptomatic disease and CVD specifically requires treatment that is often more problematic and more painful than the disease itself. Increasing the number of medications on the regimen or number of doses per day complicates matters further. The average patient with hypertension needs 2 to 3 antihypertensives to reach and maintain BP control. 3 Oncedaily hypertensive therapy can be quite helpful.

Maintaining Quality of Life
Must a good antihypertensive effect change quality of life? Researchers compared nebivolol 5 mg and the angiotensin II receptor blocker losartan 50 mg in a double-blind, randomized, parallel study of 314 patients with hypertension over 12 weeks. Both drugs were given once daily. If diastolic response was inadequate after 6 weeks, they added 12.5 mg of hydrochlorothiazide once daily. The drugs' effect on systolic BP was similar, but nebivolol decreased diastolic BP to a greater degree than did losartan. Significantly more losartan-treated patients required supplementary hydrochlorothiazide to achieve BP control than did those treated with nebivolol, thus increasing the number of drugs they were taking. Patients reported similar quality of life (including sexual function) at 6 and 12 weeks. Headache occurred more frequently in the losartan arm. 4 Use of nebivolol may allow monotherapy to a greater extent, improving adherence and reducing copayment burden.
Quality improvement programs can help with adherence issues. Fonarow et al. organized pharmacists and nurses to promote appropriate medications for heart failure patients and to work with hospitalized patients before discharge. 5 Called the Cardiac Hospitalization Atherosclerosis Management Program (CHAMP), it promoted initiation of aspirin, cholesterol-lowering medication, beta-blocker, and angiotension-converting enzyme inhibitor (ACEI) therapies. Hospital staff also counseled patients about diet and exercise at the time of hospital discharge. Treatment rates and clinical outcome were compared in patients discharged after myocardial infarction (MI) in the 2-year periods before and after program implementation. As a consequence of this intervention, aspirin use increased from 68% to 92%, beta-blocker use increased from 12% to 62%, ACEI use escalated from 6% to 58%, and statin use went from 6% to 86%. These improvements were sustained during the 6-to 18-month period after hospital discharge. A larger proportion of post-CHAMP patients (58%) lowered their low-density lipoprotein cholesterol to less than 100 mg/dL compared with only 6% of patients in the pre-CHAMP group. Recurrent MI and 1-year mortality also fell. Enhancing compliance is critical, as is selection of the appropriate therapy for these patients.

Summary
Managed care pharmacists can help patients with multiple risk factors and hypertension in several ways. Healthy People 2010 goals and Health Plan Employer Data Information Set 2006 measures for hypertension will require a much more aggressive approach to achieve desired BP control rates. That means pharmacists must monitor polypharmacy aggressively and become more vigilant for patient adherence. Using an interdisciplinary approach to hypertension treatment, pharmacists can assume a major role in detection, management, and control of hypertensive patients. They must identify and screen patients who may have metabolic syndrome. Their prescription records and medical databases will be used to track drug adherence, treatment control rates, optimal therapy, and overall compliance to therapy. As the medical teams' drug experts, pharmacists will be expected to recommend best treatment options for effective BP control and cardiovascular risk reduction.

DISCLOSURES
This article is based on a presentation funded by an educational grant from Forest Pharmaceuticals. The author discloses that he has received honoraria from Forest Pharmaceuticals for participation in this supplement. He discloses the following commercial/ financial relationships through grant/research support, consultant services, speakers bureaus, and/or advisory boards: Amgen and King Pharmaceuticals.