Figure 3 Lifestyle, Blood Pressure (BP), and Economics of Hypertension (EOH). There are a high linkage among these topics. Healthier lifestyle, better BP and cardiovascular health. Herein, EOH is a novel discipline which is very beneficial in cardiovascular system and human health.
Current clinical studies are cost-saving interventions for the prevention of stroke and improvement of quality of life in individuals with hypertension, and provide evidence for the effectiveness and safety of these measures in the management of hypertension. Encouragingly, recent clinical trials found that two aldosterone synthase inhibitors baxdrostat and lorundrostat have good effects on treatment-resistant or uncontrolled hypertension [20, 21], and a RNA interference (RNAi) therapeutic agent Zilebesiran has a prolonged duration of action (up to 24 weeks) on hypertension [22]. In addition, endovascular ultrasound renal denervation is the efficacy and safety for reducing BP in patients with mild to moderate and treatment-resistant hypertension [23].
Generally, these clinical trials confirmed that intensive BP treatment is an effective and cost-effective intervention and has more the lifetime health benefits [24, 25], but implementation of intensive BP control in routine clinical practice is challenging. In fact, a multicomponent intervention of hypertension for multiple risk factors is a viable and cost-effective strategy [26-29] for responding to the growing CVD epidemic in rural communities in low-income and middle-income countries. Moreover, comprehensive and self-management of hypertension [30, 31], including pharmacist care, patient education and prescribing, in particular application of novel technologies, such as mobile health technology (WeChat), and community pharmacists, clinical decision support systems, and a plasma renin activity-guided strategy [32-34], is more effective than standard care in treating hypertension. A systolic BP target of <130 mmHg or lower is cost effective in cases who have had a stroke/transient ischaemic attack [35], and Gu D, et al. reported in 2015 that low-cost essential antihypertensive agents have the potential to prevent about 800,000 CVD events annually [36]. In fact, comparative studies [37] may tell us which agent is better, and the famous SPRINT study [38, 39] had confirmed the benefits of antihypertensive agents.
Socioeconomic status (such as insurance coverage, health care access, and neighborhood-level socioeconomic disadvantage) [40, 41] links to management of cardiovascular risk factors, long-term outcomes and mortality. Intensive blood pressure management is cost-effective even with substantially higher adverse event rates [42]. In fact, cardiovascular trials on surgical treatment vs medical therapy should assess not only clinical outcomes but also cost-effectiveness and quality of life [43]. Some innovative strategies (such as a digital health intervention using remote monitoring, gamification, and social incentives) may reduce cardiovascular risk by modification of lifestyle [44].
Lastly, since angiotensin-converting enzyme inhibitor (ACEI) but not angiotensin receptor blocker (ARB) can reduce the bacterial killing ability of neutrophils, there is at increased risk of infection among individuals receiving ACEI treatment [45]. In addition, agents from the same class could have very different adverse drug events [46] or ineffective control of hypertension [47] among individuals due to genetic variants, new technology for genetic variant detection (e.g., a cationic conjugated polymer-based multistep fluorescence resonance energy transfer technique) and personalizing therapy is crucial to the safety and efficacy. Hence, when we understand and know about related economic principles and theories, BP in the globe will have more and better protection.