Monte Carlo simulation of uncertainty to identify barriers to optimizing blood pressure control.
Monte Carlo simulation of uncertainty to identify barriers to optimizing blood pressure control.
复制标题
蒙特卡罗模拟不确定性，以确定优化血压控制的障碍。
DOI：
10.1097/hjh.0000000000002546
复制
发表时间：
2020
影响因子：
4.9
通讯作者：
Zanisi L
中科院分区：
文献类型：
--
作者：
Zanisi L
目的：评估可变的药物反应和测量误差对SBP控制的影响。方法：我们模拟了一种针对不同治疗前SBP的人群的治疗-靶向策略，即按顺序添加药物，直到测得的SBP(MSBP)<140 mm Hg。蒙特卡罗模拟测定了真收缩压(TSBP)的药物反应(药物效应±σ药物；10±5毫米汞柱)和测量误差(σMeas；10毫米汞基线)的变异性。主要结果是达到目标的个体比例低于140 mm Hg。结果：基于MSBP的决策导致35.0%的初始TSBBP为150 mm Hg的个体要么不适当地服用第二种药物，要么不适当地拒绝第二种药物。当对多个药物滴定运行模拟时，测量误差限制了所有被测人群的TBP控制。一种基于第二次测量的药物滴定策略，针对有错误决定风险的个人(MSBP120-150毫米汞柱；σ均值15毫米汞)，将超过目标的比例从最初的TSBP160毫米汞时的40.1%降低到30.0%。当二次读数的测量变异性降低到临床上常见的(σmeas 5毫米汞柱)以下时，超过目标的比例进一步下降到17.4%。结论：在本次模拟中，测量误差对达到目标的个体比例影响最大。通过重复测量、替代测量技术或改变阈值来减少这一错误的努力，是降低心血管发病率和死亡率的有希望的策略，应该在临床试验中进行研究。在这里，我们已经表明，蒙特卡罗模拟是一种有用的技术来研究不确定性对不同高血压管理策略的影响。
Objectives:To assess the impact of variable drug response and measurement error on SBP control.Methods:We simulated a treat-to-target strategy for populations with different pretreatment SBP, whereby medications were added sequentially until measured SBP (mSBP) less than 140 mmHg. Monte Carlo simulations determined variability of both drug response (drug eff±σ drug; 10±5 mmHg base case) and measurement error (σ meas; 10 mmHg base case) of true SBP (tSBP). The primary outcome measure was the proportion of individuals who achieved target less than 140 mmHg.Results:Decision-making based on mSBP resulted in 35.0% of individuals with initial tSBP 150 mmHg being either inappropriately given, or inappropriately denied a second drug. When the simulation was run for multiple drug titrations, measurement error limited tSBP control for all populations tested. A strategy of drug titration based on a second measurement for individuals at risk of incorrect decisions (mSBP 120–150 mmHg; σ meas 15 mmHg) reduced the proportion above target from 40.1 to 30.0% when initial tSBP 160 mmHg. When the measurement variability for the second reading was reduced below that usually seen in clinical practice (σ meas 5 mmHg), the proportion above target decreased further to 17.4%.Conclusion:In this simulation, measurement error had the greatest impact on the proportion of individuals achieving their SBP target. Efforts to reduce this error through repeated measures, alternative measurement techniques or changing thresholds, are promising strategies to reduce cardiovascular morbidity and mortality and should be investigated in clinical trials. Here we have shown that Monte Carlo simulations are a useful technique to investigate the influence of uncertainty for different hypertension management strategies.