Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
BMJ Open. 2019 Aug 30;9(8):e028438. doi: 10.1136/bmjopen-2018-028438.
Recent studies suggest that a systolic blood pressure (SBP) target of 120 mm Hg is appropriate for people with hypertension, but this is debated particularly in people with multiple chronic conditions (MCC). We aimed to quantitatively determine whether benefits of a lower SBP target justify increased risks of harm in people with MCC, considering patient-valued outcomes and their relative importance.
Highly stratified quantitative benefit-harm assessment based on various input data identified as the most valid and applicable from a systematic review of evidence and based on weights from a patient preference survey.
Outpatient care.
Hypertensive patients, grouped by age, gender, prior history of stroke, chronic heart failure, chronic kidney disease and type 2 diabetes mellitus.
SBP target of 120 versus 140 mm Hg for patients without history of stroke.
Probability that the benefits of a SBP target of 120 mm Hg outweigh the harms compared with 140 mm Hg over 5 years (primary) with thresholds >0.6 (120 mm Hg better), <0.4 (140 mm Hg better) and 0.4 to 0.6 (unclear), number of prevented clinical events (secondary), calculated with the Gail/National Cancer Institute approach.
Considering individual patient preferences had a substantial impact on the benefit-harm balance. With average preferences, 120 mm Hg was the better target compared with 140 mm Hg for many subgroups of patients without prior stroke, especially in patients over 75. For women below 65 with chronic kidney disease and without diabetes and prior stroke, 140 mm Hg was better. The analyses did not include mild adverse effects, and apply only to patients who tolerate antihypertensive treatment.
For most patients, a lower SBP target was beneficial, but this depended also on individual preferences, implying individual decision-making is important. Our modelling allows for individualised treatment targets based on patient preferences, age, gender and co-morbidities.
最近的研究表明，高血压患者的收缩压（SBP）目标为 120mmHg 较为合适，但这在患有多种慢性病（MCC）的人群中存在争议。我们旨在定量确定在 MCC 患者中，较低的 SBP 目标是否能带来更多的获益，同时考虑到患者重视的结局及其相对重要性。
基于系统评价中确定的最有效和适用的各种输入数据，并基于患者偏好调查的权重，进行分层量化获益-风险评估。
门诊护理。
根据年龄、性别、既往卒中史、慢性心力衰竭、慢性肾脏病和 2 型糖尿病，将高血压患者分为不同组别。
无卒中史患者的 SBP 目标为 120mmHg 与 140mmHg。
在 5 年内，SBP 目标为 120mmHg 与 140mmHg 相比，获益超过危害的概率（主要），阈值＞0.6（120mmHg 更好）、＜0.4（140mmHg 更好）和 0.4-0.6（不确定），用 Gail/National Cancer Institute 方法计算预防的临床事件数量（次要）。
考虑到个体患者的偏好对获益-风险平衡有重大影响。在平均偏好下，对于大多数无既往卒中的患者亚组，特别是 75 岁以上的患者，120mmHg 是优于 140mmHg 的目标。对于无糖尿病和既往卒中的 65 岁以下女性且合并慢性肾脏病患者，140mmHg 更好。分析未包括轻度不良反应，仅适用于能耐受降压治疗的患者。
对于大多数患者，较低的 SBP 目标是有益的，但这也取决于个体偏好，这意味着个体化决策很重要。我们的模型允许根据患者偏好、年龄、性别和合并症制定个体化的治疗目标。
