Lack of a bridge between screening and medical management for hypertension: health screening cohort in Japan
Lack of a bridge between screening and medical management for hypertension: health screening cohort in Japan
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DOI：
10.1186/s12889-020-09532-5
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发表时间：
2020-09-17
影响因子：
4.5
通讯作者：
Taguri, Masataka
中科院分区：
文献类型：
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作者：
Fukuma, Shingo;Ikenoue, Tatsuyoshi;Taguri, Masataka
背景：高血压患者在筛查中被发现后，患者的行程在普通人群中还没有得到很好的检查。因此，我们的目标是评估日本中年人群的医疗状况和随后的血压纵向变化。方法：从2014年4月到2019年3月，我们使用日本全国健康筛查队列进行了一项队列研究。在40-74岁以前没有接受过高血压治疗的健康筛查参与者中，根据筛查结果重新确定高血压患者，并评估他们在首次筛查后一年内的高血压治疗状况。结果：在153,523名筛查参与者(平均年龄=49.7岁)中，16720名(10.9%)和4150名(2.7%)新发现高血压，基线SBP分别为140-159 mm Hg(1级)和>；=160 mm Hg(2-3级)。其中，15.9%的1级高血压参与者和36.3%的2-3级高血压参与者在首次筛查后的一年内开始接受治疗。采用倾向性评分匹配的线性广义估计方程显示，在1级高血压患者中，接受治疗的患者SBP降低5.77 mm Hg(95%CI-6.64~-4.90)，DBP降低3.82 mm Hg(95%CI-4.47~-3.16)。2~3级高血压组SBP降低14.69 mm Hg(95%CI-16.35~-13.04)，DBP降低8.42 mm Hg(95%CI-9.49~-7.34)。然而，发现之后往往伴随着医疗不足和不适当的血压管理。这些发现表明，高血压患者的健康筛查和药物治疗之间的联系不充分。
Background: Patient journeys for hypertensive individuals after detection at screening have not been well examined in a general population. Thus, we aimed to assess the medical treatment status and subsequent longitudinal changes in blood pressure in a middle-aged Japanese population.Methods: We conducted a cohort study using a nationwide Japanese health screening cohort, from April 2014 to March 2019. Among health screening participants aged 40-74 years who had not previously received treatment for hypertension, hypertensive patients were newly identified based on screening results, and their medical treatment status for hypertension during the year following their initial screening was assessed. The main outcomes were longitudinal changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over 4 years after initial screening.Results: Of the 153,523 screening participants (mean age = 49.7 years), 16,720 (10.9%) and 4150 (2.7%) were newly detected as having hypertension, with baseline SBP of 140-159 mmHg (grade 1) and >= 160 mmHg (grade 2-3), respectively. Among them, 15.9% of the grade 1 hypertensive participants and 36.3% of the grade 2-3 hypertensive participants started receiving medical treatment during the year following initial screening. A linear generalised estimating equation with propensity score matching showed that receiving medical treatment was associated with 5.77 mmHg lower SBP (95% CI - 6.64 to - 4.90) and 3.82 mmHg lower DBP (95% CI - 4.47 to - 3.16) in the grade 1 hypertensive group, and 14.69 mmHg lower SBP (95% CI - 16.35 to - 13.04) and 8.42 mmHg lower DBP (95% CI - 9.49 to - 7.34) in the grade 2-3 hypertensive group.Conclusions: Health screenings detected hypertension in a substantial percentage of the middle-aged population in this study. However, detection was often followed by insufficient medical treatment and inappropriate blood pressure management. These findings indicate an inadequate link between health screenings and medical treatments in patients with hypertension.