Two studies provide additional support for lowering systolic 血压 to an intensive goal of 120 mmHg - far below the standard guidelines of 140 mmHg - to reduce the risk of heart disease in high-risk patients with hypertension. The new research shows that intensive 血压 control is well-tolerated by patients and is cost-effective in terms of health-related quality of life and financial costs to the healthcare system.
网上发表于 新英格兰医学杂志 8月. 24, the findings address ongoing debates that have been simmering since results from the Systolic Blood Pressure Intervention Trial (SPRINT) were first reported nearly two years ago.
"Intensive 血压 control improves health outcomes in high-risk patients, but it has been unclear whether the approach is cost-effective or if it's well-tolerated by patients compared to standard control,” 亚当·布雷斯，药学博士，硕士， an assistant professor of Population Health Sciences at University of Utah Health who co-led the first, 成本效益研究. 布雷斯解释说，治疗在临床实践中是不可持续的，如果, 例如, 它会让病人感到痛苦，或者价格高昂.
“集体, these results provide strong evidence that intensive control is worth considering in high-risk patients,布雷斯说。.
倾听病人的观点
平均, patients on intensive therapy often took three to four anti-hypertensive medications to reach the lower 血压 goal, 这引起了人们对副作用的担忧，比如头晕, 头晕, 或者疲劳会让人难以忍受.
治疗慢性疾病，如高血压, it is important not only to prevent cardiovascular morbidity and mortality such as heart attacks and stroke, 但也要确保接受治疗的人继续感觉良好,第二项研究的主要作者丹·伯洛维茨说, MD, Chief of Staff at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, 质量.他是波士顿大学的教授.
第二项研究考察了与健康相关的生活质量,631 SPRINT participants - about half of whom were on intensive therapy - answer standard questionnaires assessing their quality of life, 身心健康, 以及他们在临床试验期间的护理满意度.
Participants on intensive therapy reported feeling as well as those receiving standard 血压 control and were equally satisfied with their care. 他们也同样可能坚持他们的药物治疗方案, 这是治疗耐受性良好的另一个迹象.
A subpopulation considered particularly vulnerable to side effects from intensive therapy, 75岁及以上的虚弱参与者, 在密集的方法下也表现良好.
Frail, older participants began at lower measures of physical and cognitive abilities," explains Mark Supiano，医学博士, a co-author on both studies and a geriatrician at University of Utah Health and VA Salt Lake City Health Care System. 共有2560名SPRINT参与者属于这一类.
重要的是, intensive 血压 control did not further decrease quality of life measures compared to standard control even in frail, 老年人,Supiano说. Additional studies are being carried out to determine the long-term impacts of treatment.
莫莉·康罗伊，医学博士，公共卫生硕士， a professor of Internal Medicine at U of U Health was also a co-author on the two publications.
Berlowitz points out that the results don't necessarily mean that everyone with high 血压 should aim for a goal of less than 120 mmHg.
"In order for patients to have the future health benefits of intensive 血压 control while maintaining their current health-related quality of life, clinicians and patients should work together to adjust medications as needed while keeping an eye on symptoms,他说.
计算血压控制的成本
Another worry plaguing intensive therapy has been that costs of intensive treatment might overwhelm an already strained healthcare system. Reaching the lower 血压 goal requires more visits to healthcare providers, and additional medications and lab tests — all incurring expenses that add up over time. 如果严重的药物副作用导致病人住院, 这将使价格更高，并可能降低生活质量.
这个图表描述了一个模拟案例研究的结果. 5年的强化治疗导致75岁低血压, and acute kidney injury at 84 but prevents a stroke and adds six years to her life. Over the woman's lifetime, intensive treatment adds over $150,000 in healthcare costs. 图片来源：Brandon Bellows
The 成本效益研究 reports that the healthcare costs associated with intensive 血压 control are balanced by gains in health, 使其在人的一生中都具有成本效益. 强化控制成本不到50美元,每增加1个质量调整生命年，就增加1万美元, 衡量寿命和生活质量的一种指标.
许多专家认为，这一价格是美国目前面临的最大问题.S. 社会愿意支付，使其成为一项高价值投资，”布雷斯说.
由布雷斯和布兰登·贝洛斯领导的研究小组, PharmD, MS, 她是大发娱乐药物治疗研究助理教授, 在10年模拟强化和标准治疗,000名符合sprint标准的患者来得出结论. They gauged benefits and costs of intensive therapy in the face of uncertainties encountered in real life by incorporating over 250 variables, 包括一系列的病史和副作用.
"It's not possible to run clinical trials that last for decades for every type of patient,贝洛斯解释道。. "Simulation gives us a way to explore 'what if' scenarios and extrapolate short-term data to estimate a range of expected long-term outcomes."
在开始强化治疗后的10到20年内, the extra expenses were offset by the cardiac episodes and subsequent treatment costs that were prevented, 模拟显示.
强化血压治疗可以预防心脏病, 但这需要患者和医疗服务大发娱乐提供者付出额外的努力,共同资深作者安德鲁·莫兰说, MD, 英里每小时, 来自纽约哥伦比亚大学医学中心. "Our study showed that it is a very good value if the treatment is sustained long-term."
合著者Lawrence Fine医学博士.PH, Chief of the Branch of Clinical Applications and Prevention at the National Heart Lung and Blood Institute (NHLBI), says that estimates indicate there are at least 17 million Americans who could benefit from lowering their 血压.
This current study is important not just because it shows that the long-term benefits of intensive 血压 treatment outweigh considerations about costs and side effects, 而是因为它对整个人口的影响,他说.
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The work was funded by the National Institutes of Health and additional support was provided by the Department of Veterans Affairs.
这项研究将以两篇论文的形式发表：强化vs .成本效益. 标准血压控制“和”强化血压治疗对患者报告结果的影响" in NEJM 8月上线. 24, 2017.
见出版物的作者和合作机构的名单.