Borghi Claudio, Wang Jiguang, Rodionov Anton V, Rosas Martin, Sohn Il Suk, Alcocer Luis, Valentine William J, Deroche-Chibedi Daniela, Granados Denis, Croce Davide
University of Bologna, Bologna, Italy.
Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Int J Cardiol Cardiovasc Risk Prev. 2021 Aug 8;10:200102. doi: 10.1016/j.ijcrp.2021.200102. eCollection 2021 Sep.
To project the 10-year clinical outcomes associated with single pill combination (SPC) therapies compared with multi-pill regimens for the management of hypertension in five countries (Italy, Russia, China, South Korea and Mexico).
A microsimulation model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents (start low and go slow, SLGS), free choice combination with multiple pills (FCC) and combination therapy in the form of a single pill (SPC). Model inputs were derived from the Global Burden of Disease 2017 dataset. Simulated outcomes of mortality, chronic kidney disease (CKD), stroke, ischemic heart disease (IHD), and disability-adjusted life years (DALYs) were estimated for 1,000,000 patients on each treatment pathway.
SPC therapy was projected to improve clinical outcomes over SLGS, FCC and CTP in all countries. SPC reduced mortality by 5.4% in Italy, 4.9% in Russia, 4.5% in China, 2.3% in South Korea and 3.6% in Mexico versus CTP and showed greater reductions in mortality than SLGS and FCC. The projected incidence of clinical events was reduced by 11.5% in Italy, 9.2% in Russia, 8.4% in China, 4.9% in South Korea and 6.7% in Mexico for SPC versus CTP.
Ten-year projections indicated that combination therapies (FCC and SPC) are likely to reduce the burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence.
预测在五个国家（意大利、俄罗斯、中国、韩国和墨西哥）使用单片复方制剂（SPC）疗法与多片联合方案治疗高血压的10年临床结局。
设计了一个微观模拟模型，以预测2020年至2030年期间，按照四种不同治疗途径管理的高血压人群的健康结局：当前治疗实践（CTP）、先单药滴定剂量然后依次加用其他药物（起始剂量低、逐步加量，SLGS）、自由选择多片联合用药（FCC）以及单片复方制剂形式的联合治疗（SPC）。模型输入数据源自《2017年全球疾病负担》数据集。对每种治疗途径下的100万名患者估计了死亡率、慢性肾脏病（CKD）、中风、缺血性心脏病（IHD）以及伤残调整生命年（DALY）的模拟结局。
预计SPC疗法在所有国家均能比SLGS、FCC和CTP改善临床结局。与CTP相比，SPC在意大利使死亡率降低5.4%，在俄罗斯降低4.9%，在中国降低4.5%，在韩国降低2.3%，在墨西哥降低3.6%，并且在降低死亡率方面比SLGS和FCC表现更优。与CTP相比，SPC在意大利使临床事件预计发生率降低11.5%，在俄罗斯降低9.2%，在中国降低8.4%，在韩国降低4.9%，在墨西哥降低6.7%。
10年预测表明，与传统管理方法相比，联合治疗（FCC和SPC）可能减轻高血压负担，由于依从性提高，SPC显示出最大的总体益处。
