支持无并发症(低风险)轻度高血压患者开始药物治疗的证据尚无定论。因此,临床指南相互矛盾,医疗政策也经常改变.这项研究的目的是确定该人群中生活方式建议和药物治疗的发生率,以及长期趋势是否与政策变化有关。
纵向队列研究。
有助于英国临床实践研究数据链的初级保健实践。
数据是从18-74岁患者的链接电子健康记录中提取的,1期高血压(血压在140/90和159/99mmHg之间),没有心血管疾病(CVD)的危险因素,没有治疗,从1998年到2015年。如果没有随访记录,患者将退出,他们进展到2期高血压,发展了CVD危险因素或接受了生活方式建议/治疗.
政策变化与生活方式建议或治疗的发生率之间的关联,使用中断的时间序列分析进行检查。
总共108843例患者被定义为无并发症的轻度高血压(平均年龄51.9±12.9岁,60.0%女性)。患者在研究中平均花费2.6年(IQR0.9-5.5),之后,12.2%(95%CI12.0%至12.4%)接受了生活方式建议,29.9%(95%CI29.7%至30.2%)为处方药,19.4%(95%CI19.2%至19.6%)为处方药。引入质量结果框架(QOF)并随后对QOF指标进行更改后,生活方式建议的发生率显着增加。随着时间的推移,治疗处方略有下降,但与政策变化无关。
尽管长期趋势符合英国的指导,许多患者仍在接受轻度高血压的治疗。需要足够的研究来确定这是否合适。
Evidence to support initiation of pharmacological treatment in patients with uncomplicated (low risk) mild hypertension is inconclusive. As such, clinical
guidelines are contradictory and healthcare policy has changed regularly. The aim of this study was to determine the incidence of lifestyle advice and drug therapy in this population and whether secular trends were associated with policy changes.
Longitudinal cohort study.
Primary care practices contributing to the Clinical Practice Research Datalink in England.
Data were extracted from the linked electronic health records of patients aged 18-74 years, with stage 1 hypertension (blood pressure between 140/90 and 159/99 mm Hg), no cardiovascular disease (CVD) risk factors and no treatment, from 1998 to 2015. Patients exited if follow-up records became unavailable, they progressed to stage 2 hypertension, developed a CVD risk factor or received lifestyle advice/treatment.
The association between policy changes and incidence of lifestyle advice or treatment, examined using an interrupted time-series analysis.
A total of 108 843 patients were defined as having uncomplicated mild hypertension (mean age 51.9±12.9 years, 60.0% female). Patientsspent a median 2.6 years (IQR 0.9-5.5) in the study, after which 12.2% (95% CI 12.0% to 12.4%) were given lifestyle advice, 29.9% (95% CI 29.7% to 30.2%) were prescribed medication and 19.4% (95% CI 19.2% to 19.6%) were given both. The introduction of the quality outcomes framework (QOF) and subsequent changes to QOF indicators were followed by significant increases in the incidence of lifestyle advice. Treatment prescriptions decreased slightly over time, but were not associated with policy changes.
Despite secular trends that accord with UK guidance, many patients are still prescribed treatment for mild hypertension. Adequately powered studies are needed to determine if this is appropriate.