Effectiveness of treat-to-target versus risk-based blood pressure guidelines

描述（由申请人提供）：目前在美国有> 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。2010年，高血压导致的医疗保健费用估计为7660万美元4，2005年约有395，000例死亡或六分之一的死亡归因于血压升高。3传统上，美国血压指南根据血压水平和目标提出治疗建议-一种“达标治疗”方法。替代方法基于心血管事件的短期或长期风险，使用年龄，性别，血压和其他主要风险因素来估计风险-基于风险或“定制”的方法来预测治疗建议。美国人口的重要变化有可能影响这些战略的相对成本效益。这些人口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长以及超重和肥胖症流行率的增加。在美国，没有正式的临床有效性分析或成本效益分析比较这两种血压治疗方法，不过，最近也公布了其他国家的这类分析。此外，这些策略在按年龄、性别、种族/民族和肥胖状况定义的人口统计学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。使用一个经过修改和验证的CHD政策模型来预测中风、心力衰竭和终末期肾病以及CHD，我们建议：将“达标治疗”指南与基于患者预测的中期（10年）和长期（30年）心血管事件风险的“定制”指南进行比较;在1）人口老龄化，2）非洲裔美国人和墨西哥裔美国人人口增长相对较快（分别为高血压患病率较高和血压治疗率较低的人口）和3）各种肥胖和超重趋势情景。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多的人群亚组。一个最佳设计的国家BP控制计划有可能大大减轻BP相关的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费用。

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.