Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated
Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated
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DOI：
10.1136/bmj.320.7236.680
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发表时间：
2000-03-11
影响因子：
105.7
通讯作者：
Jackson, R
中科院分区：
文献类型：
--
作者：
Baker, S;Priest, P;Jackson, R
目的评估基于心血管疾病绝对风险的阈值对社区降压药物治疗的影响。设计基于心血管疾病绝对风险的高血压治疗三个阈值的模型。使用预测风险的方程估计每个参与者的5年疾病风险。计算阈值对治疗人数和5年内避免的疾病事件数的净预测影响设置奥克兰，新西兰.参与者2158名35-从普通选民名册中随机抽取79名选民。主要结果指标预测5年心血管疾病事件的风险，估计推荐治疗和避免疾病事件的人数结果46374名（12%）奥克兰35-79岁居民接受药物治疗以降低血压，估计避免了1689起疾病事件：5年以上。将治疗限制于血压大于或等于170/100 mm Hg的个体和血压在150/90-169/99 mm Hg之间且预测5年疾病风险大于或等于10%的个体，将使推荐治疗的净人数增加19 401人。与当前治疗相比，预计这42%的相对增加将在5年内避免1139/1689（68%）额外的疾病事件。如果将5年疾病风险的阈值设定为15%，则推荐治疗的数量增加< 10%，但可以避免约620/1689（37%）的额外事件。一个20%的阈值减少了约10%，但避免204/1689（12%）的疾病事件比目前treatment.Conclusions使用治疗阈值的基础上绝对风险的治疗指南，可以显着提高药物治疗的效率，以降低血压在初级保健的净人数毛皮治疗。
Objective To estimate the impact of using thresholds based on absolute risk of cardiovascular disease to target drug treatment to lower blood pressure in the community.Design Modelling of three thresholds of treatment for hypertension based on the absolute risk of cardiovascular disease. 5 year risk of disease was estimated for each participant using an equation to predict risk. Net predicted impact of the thresholds on the number of people treated and the number of disease events averted over 5 years was calculatedSetting Auckland, New Zealand.Participants 2158 men and women aged 35-79 veers randomly sampled from the general electoral rolls.Main outcome measures Predicted 5 year risk of cardiovascular disease event estimated number of people for whom treatment would be recommended and disease events averted over 5 years at different treatment thresholds.Results 46 374 (12%) Auckland residents aged 35-79 receive drug treatment to lower their blood pressure, averting an estimated 1689 disease events: over 5 years. Restricting treatment to individuals with blood pressure greater than or equal to 170/100 mm Hg and those with blood pressure between 150/90-169/99 mm Hg who have a predicted 5 year risk of disease greater than or equal to 10% would increase the net number for whom treatment would be recommended by 19 401. This 42% relative increase is predicted to avert 1139/1689 (68%) additional disease events overall over 5 years compared with current treatment. If the threshold for 5 year risk of disease is set at 15% the number recommended for treatment increases by < 10% but about 620/1689 (37%) additional events can be averted. A 20% threshold decreases the net number of patients recommended fur treatment by about 10% but averts 204/1689 (12%) more disease events than current treatment.Conclusions Implementing treatment guidelines that use treatment thresholds based on absolute risk could significantly improve the efficiency of drug treatment to lower blood pressure in primary care.