Morgan Steve, Bassett Kenneth L, Wright James M, Yan Lixiang
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.
PLoS Med. 2005 Apr;2(4):e80. doi: 10.1371/journal.pmed.0020080. Epub 2005 Apr 26.
Evidence of reduced cardiovascular morbidity and mortality as well as cost support thiazide diuretics as the first-line choice for treatment of hypertension. The purpose of this study was to determine the proportion of senior hypertensives that received thiazide diuretics as first-line treatment, and to determine if cardiovascular and other potentially relevant comorbidities predict the choice of first-line therapy.
British Columbia PharmaCare data were used to determine the cohort of seniors (residents aged 65 or older) who received their first reimbursed hypertension drug during the period 1993 to 2000. These individual records were linked to medical and hospital claims data using the British Columbia Linked Health Database to find the subset that had diagnoses indicating the presence of hypertension as well as cardiovascular and other relevant comorbidities. Rates of first-line thiazide prescribing as proportion of all first-line treatment were analysed, accounting for patient age, sex, overall clinical complexity, and potentially relevant comorbidities. For the period 1993 to 2000, 82,824 seniors who had diagnoses of hypertension were identified as new users of hypertension drugs. The overall rate at which thiazides were used as first-line treatment varied from 38% among senior hypertensives without any potentially relevant comorbidity to 9% among hypertensives with previous acute myocardial infarction. The rate of first-line thiazide diuretic prescribing for patients with and without potentially relevant comorbidities increased over the study period. Women were more likely than men, and older patients were more likely than younger, to receive first-line thiazide therapy.
Findings indicate that first-line prescribing practices for hypertension are not consistent with the evidence from randomized control trials measuring morbidity and mortality. The health and financial cost of not selecting the most effective and least costly therapeutic options are significant.
有证据表明，噻嗪类利尿剂可降低心血管疾病的发病率和死亡率，且成本较低，因此是治疗高血压的一线选择。本研究的目的是确定接受噻嗪类利尿剂作为一线治疗的老年高血压患者的比例，并确定心血管疾病和其他潜在相关合并症是否可预测一线治疗方案的选择。
利用不列颠哥伦比亚省药物护理数据确定了1993年至2000年期间首次报销高血压药物的老年患者（65岁及以上居民）队列。这些个人记录通过不列颠哥伦比亚省联合健康数据库与医疗和医院理赔数据相链接，以找出诊断显示患有高血压以及心血管疾病和其他相关合并症的子集。分析了一线使用噻嗪类药物的比例占所有一线治疗的比例，并考虑了患者年龄、性别、总体临床复杂性和潜在相关合并症。在1993年至2000年期间，82824名被诊断患有高血压的老年人被确定为高血压药物的新使用者。噻嗪类药物作为一线治疗的总体使用率从无任何潜在相关合并症的老年高血压患者中的38%到有过急性心肌梗死的高血压患者中的9%不等。在研究期间，有和没有潜在相关合并症的患者一线使用噻嗪类利尿剂的比例都有所增加。女性比男性更有可能，老年患者比年轻患者更有可能接受一线噻嗪类治疗。
研究结果表明，高血压的一线处方做法与测量发病率和死亡率的随机对照试验的证据不一致。不选择最有效和成本最低的治疗方案所带来的健康和财务成本是巨大的。
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