ベテラン保健局における高血圧に対する第一線β阻害剤の使用
Catherine G Derington1, Ransmond O Berchie1, April F Mohanty2,3
1Intermountain Healthcare Department of Population Health Sciences, Divisions of Health System Innovation and Research and Biostatistics, Spencer Fox-Eccles School of Medicine, University of Utah, Salt Lake City.
JAMA network open
|August 27, 2025
まとめ
ほとんどの退役軍人は ガイドラインに反して 明確な医学的必要性なしに 高血圧のベータブロッカーを投与しました 高齢者,女性,白人,弱い退役軍人は ガイドラインに合わない治療を受ける可能性が高くなりました
科学分野:
- 心臓病科
- 薬理学について
- 公衆衛生
背景:
- 2014年以来の米国のガイドラインは,特定の条件のない高血圧の第一線治療としてβ阻害剤を推奨していません.
- 脳卒中と死亡率の減少のための代替品と比較して,その耐受性と有効性に関して懸念があります.
- このガイドラインに合わない使用の実際の実践パターンと影響要因は不明である.
研究 の 目的:
- 確固たる指示がない高血圧患者のファーストラインベータブロッカーの使用率を決定する.
- このガイドラインに合わない処方慣行に関連する人口統計学的および臨床的要因を特定する.
主な方法:
- Veterans Health Administration (2000-2022) の患者レベルのデータを分析した連続的横断研究が行われました.
- 新規に高血圧と診断された抗高血圧薬の新規使用者も含まれていた.
- 多変量ポアソン回帰は,説得力のある兆候のない患者でベータブロッカーの開始に関連した要因を評価した.
主要な成果:
- 3,138,304人の退役軍人のうち, 24.7%がベータブロッカーを服用し, 88.2%は説得力のある症状がなかった.
- ガイドラインに合わない使用率は91. 8% (2000年−2005年) から81. 5% (2018年−2022年) に減少した.
- 高齢の女性,非ヒスパニック系白人,弱体退役軍人は ベータブロッカーの開始率が高かった.
結論:
- 退役軍人の有意な割合は 高血圧のベータブロッカーを 強い理由もなく服用しています
- 年齢,性別,人種,弱さ など の 要因 が この 慣行 と 関連 し て い ます.
- ガイドラインに沿った高血圧管理を促進するには,介入が必要である.
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