Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Bromley-by-Bow Health Centre, London, UK.
BMJ Open. 2021 Dec 30;11(12):e052884. doi: 10.1136/bmjopen-2021-052884.
To characterise gaps in antihypertensive treatment in people with hypertension and statin treatment in people with cardiovascular diseases (CVD) in a large urban population and quantify the health and economic impacts of their optimisation.
A cross-sectional population study and a long-term CVD decision model.
Primary care, UK.
All adults with diagnosed hypertension or CVD in a population of about 1 million people, served by 123 primary care practices in London, UK in 2019.
Following UK clinical guidelines, all adults with diagnosed hypertension were categorised into optimal, suboptimal and untreated groups with respect to their antihypertensive treatment, and all adults with diagnosed CVD were categorised in the same manner with respect to their statin treatment.
Proportion of patients suboptimally treated or untreated. Projected cardiovascular events avoided, years and quality-adjusted life years (QALYs) gained and healthcare costs saved with optimised treatments.
21 954 of the 91 828 adults with hypertension (24%; mean age 59 years; 49% women) and 9062 of the 23 723 adults with CVD (38%; mean age 69 years; 43% women) were not optimally treated with antihypertensive or statin treatment, respectively. Per 1000 additional patients optimised over 5 years, hypertension treatment is projected to prevent 25 (95% CI 16 to 32) major vascular events (MVEs) and 7 (3 to 10) vascular deaths, statin treatment, 28 (22 to 33) MVEs and 6 (4 to 7) vascular deaths. Over their lifespan, a patient with uncontrolled hypertension aged 60-69 years is projected to gain 0.64 (95% CI 0.36 to 0.87) QALYs with optimised hypertension treatment, and a similarly aged patient with previous CVD not optimally treated with statin is projected to gain 0.3 (0.24 to 0.37) QALYs with optimised statin treatment. In both cases, the hospital cost savings minus extra medication costs were about £1100 per person over remaining lifespan.
Optimising cardiovascular treatments can cost-effectively reduce cardiovascular risk and improve life expectancy.
在一个大型城市人群中，描述高血压患者降压治疗和心血管疾病（CVD）患者他汀类药物治疗中的差距，并量化其优化的健康和经济影响。
一项横断面人群研究和一项长期 CVD 决策模型。
初级保健，英国。
英国伦敦的 123 个基层医疗实践服务的约 100 万人群中，患有高血压或 CVD 的所有成年人。
根据英国临床指南，所有诊断为高血压的成年人根据其降压治疗分为最佳、次优和未治疗组，所有诊断为 CVD 的成年人也根据其他汀类药物治疗分为相同的组别。
21954 名高血压患者（24%；平均年龄 59 岁；49%为女性）和 9062 名 CVD 患者（38%；平均年龄 69 岁；43%为女性）未接受最佳降压或他汀类药物治疗。在 5 年内每增加 1000 名接受优化治疗的患者，预计降压治疗可预防 25 例（95%CI16 至 32）主要血管事件（MVE）和 7 例（3 至 10）血管死亡，他汀类药物治疗可预防 28 例（22 至 33）MVE 和 6 例（4 至 7）血管死亡。在其一生中，60-69 岁年龄未控制高血压的患者预计接受优化降压治疗可获得 0.64（95%CI0.36 至 0.87）QALY，而年龄相仿的先前 CVD 患者未接受他汀类药物最佳治疗，预计接受优化他汀类药物治疗可获得 0.3（0.24 至 0.37）QALY。在这两种情况下，在剩余的寿命内，每个人的医院成本节约减去额外药物成本约为 1100 英镑。
优化心血管治疗可以以具有成本效益的方式降低心血管风险并延长预期寿命。
