Department of Health Services Administration and Policy, Temple University, Philadelphia, Pennsylvania, USA.
American Medical Association, Chicago, Illinois, USA.
Am J Hypertens. 2022 Mar 8;35(3):225-231. doi: 10.1093/ajh/hpab162.
In response to high prevalence of hypertension and suboptimal rates of blood pressure (BP) control in the United States, the Surgeon General released a Call-to-Action to Control Hypertension (Call-to-Action) in the fall of 2020 to address the negative consequences of uncontrolled BP. In addition to morbidity and mortality associated with hypertension, hypertension has an annual cost to the US healthcare system of $71 billion. The Call-to-Action makes recommendations for improving BP control, and the purpose of this review was to summarize the literature on the cost-effectiveness of these strategies. We identified a number of studies that demonstrate the cost saving or cost-effectiveness of recommendations in the Call-to-Action including strategies to promote access to and availability of physical activity opportunities and healthy food options within communities, advance the use of standardized treatment approaches and guideline-recommended care, to promote the use of healthcare teams to manage hypertension, and to empower and equip patients to use self-measured BP monitoring and medication adherence strategies. While the current review identified numerous cost-effective methods to achieve the Surgeon General's recommendations for improving BP control, future work should determine the cost-effectiveness of the 2017 American College of Cardiology and American Heart Association Hypertension guidelines, interventions to lower therapeutic inertia, and optimal team-based care strategies, among other areas of research. Economic evaluation studies should also be prioritized to generate more comprehensive data on how to provide efficient and high value care to improve BP control.
针对美国高血压患病率高和血压(BP)控制率不理想的情况,美国外科医生于 2020 年秋季发布了《控制高血压行动呼吁》(Call-to-Action),以应对不受控制的 BP 的负面影响。除了与高血压相关的发病率和死亡率外,高血压每年给美国医疗保健系统造成 710 亿美元的损失。该行动呼吁提出了改善 BP 控制的建议,本综述的目的是总结这些策略的成本效益的文献。我们确定了许多研究,这些研究证明了行动呼吁中的建议具有节省成本或成本效益,包括促进社区内获得和提供体育活动机会和健康食品选择的策略,推进使用标准化治疗方法和指南推荐的护理,促进使用医疗团队来管理高血压,以及授权和装备患者使用自我测量 BP 监测和药物依从性策略。虽然目前的综述确定了许多实现改善 BP 控制的外科医生建议的具有成本效益的方法,但未来的工作应该确定降低治疗惰性的干预措施以及最佳的基于团队的护理策略等其他研究领域的 2017 年美国心脏病学会和美国心脏协会高血压指南的成本效益。还应优先进行经济评估研究,以生成有关如何提供高效和高价值的护理以改善 BP 控制的更全面的数据。