Patient preferences in pharmaceutical and device-based treatments for uncontrolled hypertension

Objective: Radiofrequency renal denervation (RDN) safely reduces high blood pressure (BP) in hypertensive (HTN) patients. Patient preference regarding such a treatment over antihypertensive (AH) drugs for uncontrolled HTN is poorly understood. Design and method: A recent discrete choice experiment (DCE) study in patients with uncontrolled HTN identified the reduction in systolic BP as the most important driver of patient preference between interventional treatments (e.g. RDN) or drugs. Using a predictive model consisting of the preference weights for safety and efficacy attributes from the DCE study, we calculated patients’ treatment preferences in 3 typical clinical scenarios in HTN management. Each scenario presented a choice to either initiate/increase AH drugs, or to have interventional treatment such as RDN: (1) AH drug naïve: initiate AH drugs vs. interventional treatment (2) mild-moderate HTN, 1-3 AH drugs: increasing AH drugs vs. intervention with no drug changes, (3) severe HTN (systolic BP >150mmHg, >3 AH drugs): increasing AH drugs vs. intervention with no drug changes. In each scenario, the average predicted probability of choosing one treatment over the other was calculated based on a benefit-risk profile from the sum of preference-weighted treatment attributes (type of treatment, changes in AH drugs, office systolic BP reducing efficacy, effect duration, risk of drug side effects, interventional treatment adverse events). Values of the treatment attributes were derived from the literature, expert opinion, and published RDN studies (SPYRAL HTN OFF-MED, ON-MED, Global SYMPLICITY Registry). Results: In (1), 17% preferred interventional treatment without drugs vs 83% preferred initiation of drugs. In (2), 24% preferred interventional treatment without increasing drugs vs 76% preferred increasing drugs. In (3), 45% preferred interventional treatment without increasing drugs vs 55% preferred increasing drugs. Preference differences were driven by the magnitude of office systolic BP reductions with each treatment. Risks of treatment-related adverse events were less important to treatment choices. Conclusions: Preference for RDN ranged from one-fifth to one-half of patients depending on clinical scenario. The increase mirrored the extent of prior treatment with AH drugs and HTN severity on drugs. Patient preference was driven predominantly by efficacy and minimally by safety of treatment.