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.