Differing treatment pathways for the management of hypertension: long-term clinical projections in Russia

Aim. Management of hypertension, a major cause of mortality worldwide, is difficult, with adherence a common problem. The present study aimed to estimate the long-term clinical outcomes associated with different treatment pathways in people with hypertension in Russia.Material and methods. Outcomes were projected over 10 years using a microsimulation model. Four treatment pathways (current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents [start low and go slow, SLGS], free choice combination with multiple pills (FCC) and combination therapy in a single pill (SPC)) were evaluated based on the Global Burden of Disease 2017 dataset. Clinical outcomes were simulated for 1,000,000 individuals for each pathway.Results. Long-term projections associated SPC therapy with reductions in mortality (4.9%), disability-adjusted life years (DALYs, 5.2%), and incidence of complications (including chronic kidney disease, stroke and ischemic heart disease, 9.2%) versus CTP, with greater reductions in all outcomes versus SLGS and FCC. SPC was projected to save 1,193 DALYs compared with CTP over 10 years. Adherence was identified as a key driver in the analysis.Conclusion. Based on 10-year projections, combination therapies (including SPC and FCC) appear likely to reduce the burden of hypertension compared with conventional treatment options in Russia.