Department of Epidemiology and Public Health, University College London, London, UK.
Department of Epidemiology and Public Health, University College London, London, UK.
Lancet Healthy Longev. 2023 Sep;4(9):e470-e477. doi: 10.1016/S2666-7568(23)00129-0. Epub 2023 Aug 10.
Previous estimates of the impact of public health interventions targeting hypertension usually focus on one health outcome. This study aims to consider the effects of change in future hypertension prevalence on mortality, dementia, and disability simultaneously.
We modelled three plausible scenarios based on observed trends of hypertension prevalence from 2003 to 2017 in England: observed trends continue (baseline scenario); 2017 prevalence remains unchanged; and 2017 prevalence decreases by 50% by 2060. We used a probabilistic Markov model to integrate calendar trends in incidence of cardiovascular disease, dementia, disability, and mortality to forecast their future occurrence in the population of England and Wales. Assuming the hypertension prevalence trend modifies health transition probabilities, we compared mortality outcomes and the burden of dementia and disability to 2060 for the scenarios.
If the decline in hypertension prevalence stops, there would be a slight increase in the number of additional deaths to 2060 (22·9 [95% uncertainty interval 19·0-26·6] more deaths per 100 000 population), although the burdens of disability and dementia in absolute terms would change little. Alternatively, if the downward hypertension prevalence trend accelerates (with prevalence falling by 50% between 2017 and 2060), there would be a modest additional reduction in deaths (57·0 [50·4-63·5] fewer deaths per 100 000 population), a small increase in dementia burden (9·0 [5·1-13·2] more cases per 100 000 population), no significant effect on disability burden, and an 8% gain in healthy life expectancy at age 65 years from 2020 to 2060 (5·3 years vs 4·9 years) compared with the baseline scenario.
The major future impact of alternative hypertension prevention strategies appears to be on future life expectancy. The salutary effect of lower population blood pressure distribution on incidence of dementia and disability might not offset expansion of the susceptible population due to reduced mortality.
British Heart Foundation and UK Economic and Social Research Council.
先前针对高血压的公共卫生干预措施影响的评估通常只关注一个健康结果。本研究旨在同时考虑未来高血压患病率变化对死亡率、痴呆症和残疾的影响。
我们根据英格兰 2003 年至 2017 年高血压患病率的观察趋势，构建了三种可能的情景：观察趋势持续（基线情景）；2017 年患病率保持不变；到 2060 年，2017 年的患病率降低 50%。我们使用概率马尔可夫模型来整合心血管疾病、痴呆症、残疾和死亡率的发病率的日历趋势，以预测它们在英格兰和威尔士人群中的未来发生情况。假设高血压患病率趋势改变了健康转移概率，我们比较了 2060 年各情景的死亡率结果以及痴呆症和残疾负担。
如果高血压患病率下降趋势停止，到 2060 年，死亡人数将略有增加（每 10 万人增加 22.9 [95%置信区间 19.0-26.6]人死亡），尽管绝对残疾和痴呆症负担变化不大。或者，如果高血压患病率下降的下降趋势加速（2017 年至 2060 年间患病率下降 50%），则死亡人数将适度减少（每 10 万人减少 57.0 [50.4-63.5]人），痴呆症负担略有增加（每 10 万人增加 9.0 [5.1-13.2]例），残疾负担没有显著影响，与基线情景相比，2020 年至 2060 年，65 岁人群的健康预期寿命将增加 8%（从 4.9 年增加到 5.3 年）。
替代高血压预防策略的主要未来影响似乎是对未来预期寿命的影响。由于死亡率的降低，人群血压分布降低对痴呆症和残疾发病率的有益影响可能不会抵消易感人群的扩大。
英国心脏基金会和英国经济和社会研究理事会。
