将个人级别的治疗效果和结果偏好纳入个性化血压目标建议
Simon B Ascher1,2, Richard L Kravitz2, Rebecca Scherzer1
1Department of Internal Medicine, Kidney Health Research Collaborative San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CA.
根据个体患者的风险和偏好,定制血压 (BP) 目标可以完善治疗建议. 大多数SPRINT试验的参与者显示,净益处有利于密集降低血压.
科学领域:
- 心血管医学 心血管医学
- 临床试验 临床试验
- 卫生经济学 卫生经济学
背景情况:
- 关于高血压 (BP) 目标的共同决策,目前还没有确立的框架.
- 系统性血压干预试验 (SPRINT) 提供了可能被个性化的数据.
研究的目的:
- 为了确定SPRINT试验结果是否可以根据个体患者量身定制.
- 评估预测风险和模拟偏好在指导BP目标选择中的有用性.
主要方法:
- 开发并验证了Cox模型,以预测密集和标准BP降低之间的个体风险差异.
- 使用模拟偏好权重来计算净收益的综合个人治疗效应.
- 在具有高和低不良事件 (AE) 风险的参与者之间比较净收益.
主要成果:
- 在对心血管事件,认知障碍和死亡的加权比AE更重的模拟中,100%的参与者显示净益有利于密集降低血压 (中位净益:3.3个百分点).
- 当对益处和危害进行类似加权时,87%的参与者获得了积极的净益 (中位净益:0.8个百分点).
- 与较低风险的参与者相比,具有较高的AE风险的参与者仍然表明,与具有较低风险的参与者相比,从密集的BP降低中获得的净益更大.
结论:
- 在大多数SPRINT参与者中观察到有利于密集降低BP的预测净收益.
- 这种净收益的规模在个人之间有很大差异.
- 根据个人的风险概况和偏好来个性化BP目标建议是一种有希望的方法.
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