Impact of Therapeutic Inertia on Long-Term Blood Pressure Control: A Monte Carlo Simulation Study.
Impact of Therapeutic Inertia on Long-Term Blood Pressure Control: A Monte Carlo Simulation Study.
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治疗惰性对长期血压控制的影响：蒙特卡罗模拟研究。
DOI：
10.1161/hypertensionaha.120.15866
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Augustin A
中科院分区：
文献类型：
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作者：
Augustin A
抗高血压药物治疗基于响应血压（BP）测量升高的逐步滴定。然而，测量值并不一定代表个体的真实血压（由于随机误差和生物变异性），并且当测量值高于目标值（治疗惯性）时，药物并不总是增加。我们开发了一个为期 10 年的蒙特卡罗模型，以研究在存在治疗惯性的情况下测量误差如何影响收缩压 (SBP) 控制。当 SBP 测量值在 140 至 159 mm Hg 范围内时，升级治疗的概率由伯努利概率质量函数确定，该函数由探索不同惯性曲线的加权函数参数化。使用接近临床实践的加权函数模拟惯性导致约 50% 的人未能在 10 年时间范围内实现其 SBP 目标。观察到测量误差和收缩压控制之间存在反比关系。这表明，只有改变潜在的惯性概率，准确的收缩压测量的价值才能实现，也就是说，患者/临床医生相信测量是准确的，因此更有可能采取行动。在治疗开始期间消除惯性（即逐步滴定直到 SBP 测量值低于目标）改善了所有模拟的真实 SBP 控制。我们的模拟表明，治疗开始期间治疗惰性的影响在长期随访期间持续存在。无论血压测量技术如何，在治疗开始期间消除治疗惰性的策略（即双重抗高血压治疗）都可能改善长期血压控制。
Antihypertensive drug treatment is based on stepped titration in response to elevated blood pressure (BP) measurements. However, measurements do not necessarily represent an individual’s true BP (due to random error and biological variability), and medications are not always increased when measurements are above target (therapeutic inertia). We developed a Monte Carlo model with a 10-year horizon to investigate how measurement error impacted systolic BP (SBP) control in the presence of therapeutic inertia. When SBP measurements were in the range 140 to 159 mm Hg, the probability of escalating treatment was determined by a Bernoulli probability mass function parameterized by weighting functions exploring distinct inertia profiles. Simulating inertia with the weighting function that approximated to clinical practice resulted in ≈50% of individuals failing to achieve their SBP target within the 10-year time horizon. An inverse relationship was observed between measurement error and SBP control. This suggests that the value of accurate SBP measurement is only realized if it changes the underlying probability of inertia—that is, patients/clinicians believe a measurement to be accurate and so are more likely to act upon it. Removal of inertia during treatment initiation (ie, stepped titration until SBP measurement was below target) improved true SBP control for all simulations. Our simulations show that the impact of therapeutic inertia during treatment initiation persists during long-term follow-up. Strategies to remove therapeutic inertia during treatment initiation (ie, dual antihypertensive therapy) are likely to improve long-term BP control irrespective of BP measurement technique.