Analysis of Therapeutic Inertia and Race and Ethnicity in the Systolic Blood Pressure Intervention Trial: A Secondary Analysis of a Randomized Clinical Trial.
Analysis of Therapeutic Inertia and Race and Ethnicity in the Systolic Blood Pressure Intervention Trial: A Secondary Analysis of a Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2021.43001
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Bress AP
中科院分区：
文献类型：
--
作者：
Zheutlin AR;Mondesir FL;Derington CG;King JB;Zhang C;Cohen JB;Berlowitz DR;Anstey DE;Cushman WC;Greene TH;Ogedegbe O;Bress AP
不同种族和民族参与者群体中高血压治疗惰性的普遍程度是否相似？在对收缩压干预试验的 8556 名参与者进行的二次横断面分析中，在血压高于随机治疗目标的参与者中，非西班牙裔白人和西班牙裔参与者的治疗惯性发生频率相似，但非西班牙裔黑人与非西班牙裔白人参与者的治疗惯性较低。这些发现表明，在临床实践中实施高度标准化的血压测量和治疗方案，例如在临床试验环境中实施的方案，可以减少血压控制方面的种族和民族差异。这项横断面研究探讨了收缩压干预试验参与者的治疗惰性是否存在种族和民族差异。治疗惰性可能会导致血压（BP）控制方面的种族和民族差异。确定收缩压干预试验 (SPRINT) 中种族和民族与治疗惰性之间的关联。这项横断面研究是对 SPRINT 数据的二次分析，SPRINT 是一项随机临床试验，比较强化（<120 mm Hg）与标准（<140 mm Hg）收缩压治疗目标。参与者于2010年11月8日至2013年3月15日期间入组，中位随访时间为3.26年。参与者包括 50 岁或以上、心血管疾病高危人群，但没有糖尿病、既往中风或心力衰竭的成年人。目前的分析仅限于测量血压高于目标的参与者访问。本研究的分析是在 2020 年 10 月至 2021 年 3 月期间进行的。参与者自我报告的种族和民族，相互排斥地分为西班牙裔、非西班牙裔黑人或非西班牙裔白人群体。治疗惰性，定义为在每次研究访视时血压高于目标值时没有强化抗高血压药物治疗。使用广义估计方程估计自我报告的种族和民族与治疗惰性之间的关联，并按治疗组进行分层。每次访视时均通过药瓶库存评估抗高血压药物的使用情况。使用自动化设备测量血压。共有 8556 名参与者，其中标准组 4141 名（22 844 名参与者访问；中位年龄 67.0 岁 [IQR，61.0-76.0 岁]；1467 名女性 [35.4%]）和强化组 4415 名（35 453 名参与者访问；中位年龄 67.0 岁 [IQR， 61.0-76.0 岁]；1584 名女性 [35.9%]）至少有 1 次符合条件的研究访问被纳入本分析。在非西班牙裔白人、非西班牙裔黑人和西班牙裔参与者中，标准组与强化组的治疗惰性总体患病率分别为 59.8%（95% CI，58.9%-60.7%）vs 56.0%（95% CI，55.2%-56.7%）、56.8%（95% CI，54.4%-59.2%）vs分别为 54.5%（95% CI，52.4%-56.6%）和 59.7%（95% CI，56.5%-63.0%）与 51.0%（95% CI，47.4%-54.5%）。标准组和强化组中与非西班牙裔黑人与非西班牙裔白人参与者相关的治疗惰性的调整比值比分别为 0.85 (95% CI, 0.79-0.92) 和 0.94 (95% CI, 0.88-1.01)。标准组和强化组中西班牙裔与非西班牙裔白人参与者的治疗惰性调整后比值比分别为 1.00（95% CI，0.90-1.13）和 0.89（95% CI，0.79-1.00）。在血压高于目标的 SPRINT 参与者中，这项横断面研究发现，与非西班牙裔白人参与者相比，非西班牙裔黑人和西班牙裔参与者的治疗惰性患病率相似或更低。这些发现表明，SPRINT 中使用的标准化血压管理方法可能有助于确保公平护理，并可以减少治疗惰性对高血压差异的影响。 ClinicalTrials.gov 标识符：NCT01206062
Is the prevalence of therapeutic inertia for the treatment of hypertension similar across racial and ethnic participant groups? In this secondary cross-sectional analysis of 8556 participants in the Systolic Blood Pressure Intervention Trial , among participants with blood pressure above their randomized treatment goal, therapeutic inertia occurred at similar frequencies among non-Hispanic White and Hispanic participants but was lower among non-Hispanic Black vs non-Hispanic White participants. These findings suggest that implementing highly standardized blood pressure measurement and treatment protocols in clinical practice, such as those imposed in clinical trial settings, may reduce racial and ethnic disparities in blood pressure control. This cross-sectional study examines whether racial and ethnic differences were present for therapeutic inertia among participants in the Systolic Blood Pressure Intervention Trial. Therapeutic inertia may contribute to racial and ethnic differences in blood pressure (BP) control. To determine the association between race and ethnicity and therapeutic inertia in the Systolic Blood Pressure Intervention Trial (SPRINT). This cross-sectional study was a secondary analysis of data from SPRINT, a randomized clinical trial comparing intensive (<120 mm Hg) vs standard (<140 mm Hg) systolic BP treatment goals. Participants were enrolled between November 8, 2010, and March 15, 2013, with a median follow-up 3.26 years. Participants included adults aged 50 years or older at high risk for cardiovascular disease but without diabetes, previous stroke, or heart failure. The present analysis was restricted to participant visits with measured BP above the target goal. Analyses for the present study were performed in from October 2020 through March 2021. Self-reported race and ethnicity, mutually exclusively categorized into groups of Hispanic, non-Hispanic Black, or non-Hispanic White participants. Therapeutic inertia, defined as no antihypertensive medication intensification at each study visit where the BP was above target goal. The association between self-reported race and ethnicity and therapeutic inertia was estimated using generalized estimating equations and stratified by treatment group. Antihypertensive medication use was assessed with pill bottle inventories at each visit. Blood pressure was measured using an automated device. A total of 8556 participants, including 4141 in the standard group (22 844 participant-visits; median age, 67.0 years [IQR, 61.0-76.0 years]; 1467 women [35.4%]) and 4415 in the intensive group (35 453 participant-visits; median age, 67.0 years [IQR, 61.0-76.0 years]; 1584 women [35.9%]) with at least 1 eligible study visit were included in the present analysis. Among non-Hispanic White, non-Hispanic Black, and Hispanic participants, the overall prevalence of therapeutic inertia in the standard vs intensive groups was 59.8% (95% CI, 58.9%-60.7%) vs 56.0% (95% CI, 55.2%-56.7%), 56.8% (95% CI, 54.4%-59.2%) vs 54.5% (95% CI, 52.4%-56.6%), and 59.7% (95% CI, 56.5%-63.0%) vs 51.0% (95% CI, 47.4%-54.5%), respectively. The adjusted odds ratios in the standard and intensive groups for therapeutic inertia associated with non-Hispanic Black vs non-Hispanic White participants were 0.85 (95% CI, 0.79-0.92) and 0.94 (95% CI, 0.88-1.01), respectively. The adjusted odds ratios for therapeutic inertia comparing Hispanic vs non-Hispanic White participants were 1.00 (95% CI, 0.90-1.13) and 0.89 (95% CI, 0.79-1.00) in the standard and intensive groups, respectively. Among SPRINT participants above BP target goal, this cross-sectional study found that therapeutic inertia prevalence was similar or lower for non-Hispanic Black and Hispanic participants compared with non-Hispanic White participants. These findings suggest that a standardized approach to BP management, as used in SPRINT, may help ensure equitable care and could reduce the contribution of therapeutic inertia to disparities in hypertension. ClinicalTrials.gov identifier: NCT01206062
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影响因子：
8.3
作者：
Aggarwal, Rahul;Chiu, Nicholas;Kazi, Dhruv S.
通讯作者：
Kazi, Dhruv S.
影响因子：
6.3
作者：
Holmes HM;Luo R;Hanlon JT;Elting LS;Suarez-Almazor M;Goodwin JS
通讯作者：
Goodwin JS
DOI：
10.1177/1740774514537404
发表时间：
2014-10
期刊：
Clinical trials (London, England)
影响因子：
--
作者：
Ambrosius WT;Sink KM;Foy CG;Berlowitz DR;Cheung AK;Cushman WC;Fine LJ;Goff DC Jr;Johnson KC;Killeen AA;Lewis CE;Oparil S;Reboussin DM;Rocco MV;Snyder JK;Williamson JD;Wright JT Jr;Whelton PK;SPRINT Study Research Group
通讯作者：
SPRINT Study Research Group
影响因子：
6.1
作者：
Odedosu, Taiye;Schoenthaleft, Antoinette;Ogedegbe, Gbenga
通讯作者：
Ogedegbe, Gbenga
影响因子：
2.8
作者：
Huebschmann, Amy G.;Mizrahi, Trina;Denberg, Thomas D.
通讯作者：
Denberg, Thomas D.