| This study presents a cost-effectiveness analysis from a third party payer's perspective using a Markov-model. Four different strategies in the management of hypertension in young male patients without established cardiovascular disease who are about to start antihypertensive drug therapy are compared: (1) Treat everybody with conventional therapy (beta-blockers or diuretics), (2) Treat everybody with an ACE-inhibitor, (3) Individualize antihypertensive therapy according to the presence or absence of left ventricular hypertrophy on electrocardiography, or (4) Individualize therapy according to the presence or absence of left ventricular hypertrophy on echocardiography. The results of the model show that ACE-inhibitors cannot be recommended as antihypertensive first-line therapy in these patients unless they become markedly cheaper because the ACE inhibitor associated gain in unadjusted and quality-adjusted life-years is small and clinically not relevant. Prescribing conventional antihypertensive therapy to everybody or performing routine ECG to individualize treatment can be recommended as strategies of choice. Further studies are needed to assess the role of routine echocardiography. |
