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

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 (IRCVD, events/year). This simulation study compared the effectiveness of two approaches to reducing IRCVDin 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 IRCVDincreases exponentially according to SBP. The population IRCVDwas calculated as the product of the distribution of SBP multiplied by IRCVDat each SBP. The cumulative IRCVDwas calculated by the definite integral from the lowest to the highest SBP of IRCVDat each SBP level. The success rates were calculated according to SBP and metabolic risk profiles in the two approaches, respectively. Results: The reduction in IRCVDwas 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 IRCVDwas estimated at 9.99 × 10-4. In contrast, even if the health program was promoted optimistically, the decrease in IRCVDwas 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 IRCVDin virtual middle-aged Japanese men. © 2011 Ohno et al; licensee BioMed Central Ltd.