使用基于益处的量身定制治疗来改善抗高血压药物的使用
Jeremy Sussman1, Sandeep Vijan, Rod Hayward
1Division of General Internal Medicine, University of Michigan (J.S., S.V., R.H.), and the Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (J.S., S.V., R.H.).
Circulation
|November 6, 2013
概括
专注于预防心血管事件的量身定制的抗高血压药物治疗策略比目前的血压目标指南更有效. 这种方法可以预防更多的事件并节省更多的生命年,同时使用更少的药物.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
背景情况:
- 目前的抗高血压药物指南优先考虑特定的血压目标.
- 替代治疗策略的有效性仍在调查中.
研究的目的:
- 为了比较基于益处的量身定制治疗策略与抗高血压药物的传统治疗到点治疗方法的有效性.
主要方法:
- 使用美国成年人 (30-85岁) 的全国代表性样本开发了一个模拟模型.
- 该模型估计了针对治疗目标和基于益处的量身定制策略的5年治疗效果.
- 效果大小估计来自随机试验的元分析.
主要成果:
- 基于益处的量身定制治疗可以预防90万多例心血管疾病事件,并与治疗到目标相比,节省280万个质量调整的生命年.
- 这种量身定制的方法在5年内使用的药物减少了6%.
- 在子组中,以益处为基础的治疗每1000个接受治疗的人群中,以质量调整的寿命年数显著增加.
结论:
- 基于益处的量身定制治疗比目前的血压目标导向指南更有效.
- 这一策略减少了心血管疾病的发生,并改善了质量调整后的寿命.
- 量身定制的方法也导致了减少药物使用.
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