Intensive target <120 mm Hg cost-effective even in scenarios with high measurement error
By Elana Gotkine HealthDay Reporter
TUESDAY, Aug. 19, 2025 (HealthDay News) — For patients 50 years or older at high cardiovascular risk without diabetes or prior stroke, an intensive systolic blood pressure (SBP) target (<120 mm Hg) seems cost-effective at most settings with measurement error, according to a study published online Aug. 19 in the Annals of Internal Medicine.
Karen C. Smith, Ph.D., from Brigham and Women’s Hospital in Boston, and colleagues used data from the National Health and Nutrition Examination Survey to generate a simulated cohort of adults at high cardiovascular risk who met Systolic Blood Pressure Intervention Trial inclusion criteria and examined the effect of measurement error on the cost-effectiveness of intensive SBP targets. Incremental cost-effectiveness ratios (ICERs) were compared for SBP targets of less than 120, 130, and 140 mm Hg.
The researchers found that the ICER for the target of less than 120 versus less than 130 mm Hg was $24,400 per quality-adjusted life-year (QALY) with research-grade SBP measurement (mean error, 0 mm Hg) in the base-case analysis. The ICER increased to $42,000 per QALY with average measurement error (mean error, 7.3 mm Hg in the <120-mm Hg target). In sensitivity analyses, in scenarios with high error (mean error ≥14.6 mm Hg in the <120-mm Hg target), the ICER for the target of less than 120 mm Hg was greater than $100,000 per QALY, when an inflection point for increasing risk for cardiovascular disease was at or above 116 mm Hg and in scenarios with a medication-taking disutility of at least 0.003 per antihypertensive medication.
“This study should give patients at high cardiovascular risk and their clinicians more confidence in pursuing an intensive blood pressure goal,” Smith said in a statement. “Our findings suggest the intensive <120 mm Hg target prevents more cardiovascular events and provides good value, and this holds true even when measurements aren’t perfect.”
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