Comparative effectiveness analysis of treat-to-target and risk-based blood pressu

描述(由申请人提供)：目前美国有6500万成年人患有高血压。4随着人口老龄化，高血压的患病率持续增加。20104年因高血压造成的医疗保健费用估计为7,660万美元，约395,000人死亡，或者说六分之一的死亡被归因于2005.3年的高血压。传统上，美国的血压指南是基于血压水平和目标的治疗建议--“治疗对目标”的方法。替代方法以心血管事件的短期或长期风险为基础提出治疗建议，使用年龄、性别、血压和其他主要风险因素来预测风险-基于风险的或“量身定制”的方法。美国人口的重要人口结构变化有可能影响这些战略的相对成本效益。这些人口结构变化包括人口老龄化、非洲裔美国人和西班牙裔美国人在人口中所占比例的增加以及超重和肥胖患病率的增加。美国尚未发表对这两种血压治疗方法进行比较的正式临床效果分析或成本效果分析，尽管最近已在其他国家发表了此类分析。此外，对这些战略在按年龄、性别、种族/族裔和肥胖状况界定的人口群体中的比较分析尚未发表。这种分析有可能以重要的方式为治疗建议提供信息。冠心病(CHD)政策模型是美国成年人心血管疾病的流行病学和比较有效性计算机模型。使用经过调整和验证的CHD政策模型版本来预测中风、心力衰竭、终末期肾脏疾病以及CHD，我们建议：基于患者对心血管事件的中期(10年)和长期(30年)风险的预测，比较“靶向治疗”指南和“量身定制”指南；评估2010-2030年期间在以下背景下对美国成年人的影响：1)人口老龄化，2)非裔美国人和墨西哥裔美国人(分别具有较高的高血压患病率和较低的血压治疗率)相对较快的增长，以及3)各种肥胖和超重趋势。这些分析的结果有可能帮助更好地定义美国的最佳血压控制指南，并确定可能从完全实施指南中受益最大的人群亚群。一个优化设计的国家BP控制计划有可能极大地减轻BP相关发病率和死亡率的负担，同时在未来几十年每年节省数千万美元的医疗保健资金。 公共卫生相关性：大约6500万美国成年人患有高血压，与其他任何单一危险因素相比，心血管疾病死亡更多地归因于高血压。国家指南定义了高血压诊断和治疗的标准，指南决定了美国血压控制政策对健康的影响。利用高血压对美国成年人心血管疾病和终末期肾脏疾病的影响的计算机模型，我们建议比较“靶向治疗”和“量身定制”的、基于风险的血压指南的有效性，并预测未来几年在人口统计和体重变化的背景下血压控制指南的影响。这些分析的结果有可能帮助更好地定义美国的最佳血压控制指南，并确定可能从完全实施指南中受益最大的人群亚群。一个优化设计的国家血压控制计划有可能极大地减轻与血压相关的发病率和死亡率的负担，并在未来几十年每年节省数千万美元的医疗保健资金。

DESCRIPTION (provided by applicant): There are presently >65 million adults with hypertension in the United States.4 As the population ages, the prevalence of hypertension continues to increase. The health care costs due to hypertension are estimated at $76.6 million in 20104 and approximately 395,000 deaths, or one in six deaths were attributed to elevated blood pressure in 2005.3 Traditionally, U.S. blood pressure guidelines have based treatment recommendations on blood pressure levels and targets-a "treat-to-target" approach. Alternative approaches base treatment recommendations on short- or long-term risk for cardiovascular events, predicted using age, sex, blood pressure, and other major risk factors to estimate risk-a risk-based or "tailored" approach. Important demographic changes in the U.S. population have the potential to impact the relative cost effectiveness of these strategies. These demographic changes include aging of the population, growth of the proportion of African Americans and Hispanic Americans in the population, and increases in the prevalence of overweight and obesity. No formal clinical effectiveness analysis or cost-effectiveness analysis comparing these two approaches to blood pressure treatment has been published for the U.S., though such analyses have recently been published for other countries. Further, comparative analyses of these strategies in demographic groups defined by age, sex, race/ethnicity and obesity status have not been published. Such analyses have the potential to inform treatment recommendations in important ways. The Coronary Heart Disease (CHD) Policy Model is an epidemiologic and comparative effectiveness computer model of cardiovascular disease in U.S. adults. Using a version of the CHD Policy Model adapted and validated to predict stroke, heart failure and end-stage renal disease as well as CHD, we propose to: Compare "treat-to-target" guidelines to "tailored" guidelines based on patients' predicted medium term (10-year) and long term (30-year) risk for cardiovascular events; Assess the impact of both "treat-to-target" and "tailored" guidelines in U.S. adults during the years 2010-2030 in the context of 1) the aging of the population, 2) the relatively faster growth of African American and Mexican American populations (populations with higher hypertension prevalence and lower blood pressure treatment rates, respectively) and 3) various obesity and overweight trend scenarios. The results of these analyses have the potential to help better define the optimal blood pressure control guidelines for the U.S. and identify population subgroups that may benefit most from complete implementation of guidelines. An optimally designed national BP control program has the potential to greatly alleviate the burden of BP-related morbidity and mortality while saving tens of millions of health care dollars annually in coming decades. PUBLIC HEALTH RELEVANCE: Approximately 65 million U.S. adults have high blood pressure, and more of cardiovascular disease mortality is attributed to high blood pressure than to any other single risk factor. National guidelines define standards for high blood pressure diagnosis and treatment, and guidelines determine the health impact of U.S. blood pressure control policy. Using a computer model of the effects of high blood pressure on cardiovascular disease and end-stage kidney disease in U.S. adults, we propose to compare the effectiveness of "treat-to-target" and "tailored", risk-based blood pressure guidelines, and forecast the impact of blood pressure control guidelines over future years in the context of demographic and body weight changes. The results of these analyses have the potential to help to better define the optimal blood pressure control guidelines for the U.S. and identify population subgroups that may benefit most from complete implementation of guidelines. An optimally designed national blood pressure control program has the potential to greatly alleviate the burden of blood pressure-related morbidity and mortality and save tens of millions of health care dollars annually in coming decades.