退伍军人卫生管理局对高血压的第一线β-阻断剂使用
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
概括
大多数退伍军人没有明确的医疗需要, 老年人,女性,白人和脆弱的退伍军人更有可能接受这些与指导方针不一致的治疗.
科学领域:
- 心脏病学
- 药理学
- 公共卫生
背景情况:
- 自2014年以来的美国指导方针建议不使用β抑制剂作为没有特定条件的第一线高血压治疗.
- 与减轻中风和死亡率的替代药物相比,它们的耐受性和有效性存在担忧.
- 这种与指导方针不一致的实际实践模式和影响因素尚不清楚.
研究的目的:
- 确定第一线β抑制剂在缺乏强有力的指示的高血压患者中的使用率.
- 确定与非指导方针一致的处方实践相关的人口和临床因素.
主要方法:
- 一项连续的横截面研究分析了退伍军人卫生管理局 (2000-2022) 的全国患者级数据.
- 包括新诊断高血压的抗高血压药物的新用户.
- 多变量波桑回归评估了与非β阻断剂启动相关的因素.
主要成果:
- 在3,138,304名退伍军人中,有24.7%的人开始服用β抑制剂;88.2%的人缺乏令人信服的迹象.
- 与指南不一致的使用率从91.8% (2000-2005) 降至81.5% (2018-2022).
- 年龄较大,女性,非西班牙裔白人和虚弱的退伍军人,
结论:
- 很大一部分退伍军人开始服用β阻断剂治疗高血压,
- 这种习惯与年龄,性别,种族和身体脆弱等因素有关.
- 需要采取干预措施,以促进符合指南的高血压管理.
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