Antihypertensive medication versus health promotion for improving metabolic syndrome in preventing cardiovascular events: a success rate-oriented simulation study

Abstract

Abstract

Background: In practice, it is difficult to compare the effectiveness of traditional antihypertensive treatment with that of health promotion in reducing incidence rate of cardiovascular disease (IR_CVD , events/year). This simulation study compared the effectiveness of two approaches to reducing IR_CVD in a sample population: a traditional approach, in which high-risk patients are treated with conventional antihypertensive medications, and a population-based approach, in which subjects participate in a health promotion program.

Methods: We constructed a simulation model for a sample population of middle-aged Japanese men whose systolic blood pressure (SBP) levels are normally distributed (130 ± 20 mm Hg). The principal assumption was that IR_CVD increases exponentially according to SBP. The population IR_CVD was calculated as the product of the distribution of SBP multiplied by IR_CVD at each SBP. The cumulative IR_CVD was calculated by the definite integral from the lowest to the highest SBP of IR_CVD at each SBP level. The success rates were calculated according to SBP and metabolic risk profiles in the two approaches, respectively.

Results: The reduction in IR_CVD was twice as large for antihypertensive medications as it was for health promotion in several situations. For example, if adherence to antihypertensive treatment occurred at a realistic level, the decrease in IR_CVD was estimated at 9.99 × 10^-4 . In contrast, even if the health program was promoted optimistically, the decrease in IR_CVD was estimated at 4.69 × 10^-4 .

Conclusions: The success rate-oriented simulation suggests that prescribing antihypertensive medications is superior to promoting the health promotion program in reducing IR_CVD in virtual middle-aged Japanese men.