Impact Of Treatment Stage And Blood Pressure Severity On Preference For Drug And/or Device-based Treatments In Patients With Uncontrolled Hypertension

Background: Patient non-adherence to antihypertensive (AH) drugs impacts achieving treatment goals, highlighting the need for adjunctive therapies such as radiofrequency renal denervation (RDN). Patient preference for an intervention vs. drug therapy is poorly understood. We assessed patient treatment preferences at different stages of HTN management using a calculator derived from a discrete choice experiment (DCE) study. Methods: Preferences in 3 different clinical scenarios in the natural course of HTN management were evaluated: (1) initiating AH drugs vs. interventional treatment in untreated patients with mild-moderate HTN; (2) increasing drugs vs. interventional treatment with no drug change in patients with mild-moderate HTN; (3) increasing drugs vs. interventional treatment with no drug change in patients with severe resistant HTN. The predicted probability of choosing one treatment vs. the other was calculated based on preference-weighted treatment attributes (type of treatment, changes in AH drugs, BP reduction, effect duration, risk of drug side effects, intervention related adverse events). The values chosen for each scenario were derived from published RDN studies, the literature, and expert opinion. Results: Comparing scenario 1 to 2 to 3, the preference to select an intervention without drugs or change in drugs increased from 17% to 24% to 45%. Conversely, the preference to select either initiation or an increase in drugs decreased from 83% to 76% to 55%. The magnitude of BP reduction was the major driver of calculated patient preferences while drug and interventional treatment-related adverse events had a smaller impact on calculated patient preferences. Conclusions: Using preference-weights derived from a discrete choice experiment, a model predicting patient choice for drug vs. interventional treatment was applied to clinical scenarios derived from the natural course of management of patients with uncontrolled HTN. Preference for an interventional treatment increased from 17% in treatment naïve patients to 45% in patients with severe resistant HTN. Patient preference was driven predominantly by efficacy outcomes and minimally by safety concerns.