To compared blood pressure (BP) lowing effects of nitrendipine and hydrochlorothiazide (NH) and nitrendipine plus metoprolol (NM), and estimated the economic effect of these therapies on hypertension.Design and Method:
This is a randomized, open-label, prospective clinical trial, outpatients (N = 793) 18–70 years-of-age with stage 2 or severe hypertension (systolic BP ≥ 160 mmHg and/or diastolic BP ≥ 100 mmHg) were recruited from 4 rural community health centers in Beijing and Jilin. Eligible patients were randomized to receive NH or NM. Hypertension treatment costs were calculated using the maximum retail price designated by the China's national Development and Reform Commission and general estimation whereas effectiveness was measured as a reduction in systolic and diastolic BP at the end of a 24-week study period. An intent-to-treat analysis was used for comparing treatment groups.Results:
Overall 623 patients were eligible for the study and after a 24-week follow up, systolic and diastolic BP were 131.2/82.2 mmHg for the NH group and 131.4/82.9 mmHg for the NM group and these were not significantly different (P = 0.7974 systolic and P = 0.1166 diastolic). NH cost less and was more effective and the cost/effect (C/E) ratio (US$/mmHg) was 1.4 for systolic BP and 1.9 for diastolic BP for the NH group and 1.9 and 3.8 for the NM group's systolic and diastolic values, respectively. The incremental cost per mmHg for systolic and diastolic values was −8.4 and −28.7 and the incremental cost per patient for achieving target BP was 5.1.Conclusions:
Treating hypertension with NH was more cost-effective than NM and these data will allow more reasonable and efficient allocation of limited resources in low-income countries.