INTERNATIONAL RESEARCH & OPINION
8
The higher the BP, the greater the burden Severe hypertension is associated with greater life-year losses, work-year losses and costs than 'normotension', according to the results of a 19-year study in Finland. I However, the impact of mild hypertension relative to 'normotension' is not so clear. The researchers found that, relative to patients with 'normotension ' (diastolic BP < 95mm Hg), those with severe hypertension (diastolic BP > 104mm Hg) lost a significant number of life-years (mean 2.7 years for men and 2 years for women) and a significant number of work-years (mean 2.6 and 2.2 years) over the study period [see table].
Effect of diastolic blood pressure (DBP) on health outcomes and costs 'Normal' (DBP
Mild
hyperWlSlon
Se".... hyperansIon
115-104mm Hill
> 104rnm Hill
(DBP
(DBP
Men Y..,. of life !oat from: all causes
3.4
3.7
6.1"
duetoCVO"
1.5
2.3
3.5·
men and women between both severely hypertensive and 'normotensive' patients. Study baseline data were drawn from a 1972 population survey conducted in 2 eastern Finnish provinces involving nearly 11 000 subjects aged 25-29 years. Major national registers were used to collect follow-up data regarding morbidity and mortality over the 19-year period from 1972 to 1991.
Problems applying results In an accompanying editorial, Professor FO Simpson from the University of Otago, New Zealand, says that, although the Finnish study is a worthwhile and 'thoughtprovoking' analysis, there are several problems with applying the results to clinical management. 2 Notably, baseline diastolic BP was taken from a single reading - 'a highly inaccurate way of categorizing grades of hypertension'. In addition, the definitions of 'normotensive' and severely hypertensive are puzzling from a clinical perspective.
* Costs we~ ~ported in 1992 values and we~ discounted oJ 5% per annum.
1. Kiiskinen U. et aI. Long·tenn cost and life·expectancy consequences of hypertension. Journal of Hypertension 16: 1103·1112. Aug 19982. Simpson FO. Long·tenn cost and life·expectancy consequences of hypertension. 8006322>4 Jouma1 of Hypertension 16: 1099· 1100. Aug 1998
Y. . . of work !oat from: all causes
4.1
4.4
6 .7"
duetoCVD
1.2
1.7
2.9"
Costt per patient ($US thouAnda) from: all causes
73.6
80.6
118.6"
cve
20.6
29.7
SO.S-
Women Y. . . of life Ioat from: all causes
1.6
2.2
3.5"
due loCVD
0.5
0.8
2.0-
Y. . . of work !oat from: all causes
2.8
3.2
5.0·
dueloCVD
0.5
0.7
1.8'
Coett per petient ($US thouAndel from: all causes
53.4
60.8
93.2"
CVO
10.1
13.9
33.7"
• P < 00005 . vs 'nonnaI' DBP
.. caltlovasclAr disease t cI8counted at a rate of 5% per anrnm; C06Is Mf'8 reported In 1992 values
Gender differences Cardiovascular disease (CVD)-related drug costs were significantly greater for mildly and severely hypertensive men compared with 'normotensive' men ($US 1000 and $US2200 vs $US400 per patient over 19 years, respectively). * The same pattern was seen in women; however, overall CVD-related drug costs were higher for women than for men. Hospitalisation costs did not differ between diastolic BP categories for men. However, all-cause hospitalisation costs and those due to CVD alone were significantly greater for women with severe hypertension than for women with 'normal' diastolic BP or women with mild hypertension. Productivity losses because of all causes of premature death and disability were significantly different in PharmacoEconomics & Out:omes News 5 Sap 1998 No. 178
1173-550319810178-0008l$01.00'' Adl. InternatIonal Limited 1998. All rlghta reMMId
