基于马尔科夫模型的社区人群启动降压药物治疗预防心血管病的策略比较  

Comparison of initiation of antihypertensive therapy strategies for primary prevention of cardiovascular diseases in Chinese population:A decision-analytic Markov modelling study

作　　者：周恬静 刘秋萍 张明露 刘晓非 康佳丽 沈鹏[2] 林鸿波[2] 唐迅[1,3] 高培[1,3,4] ZHOU Tianjing;LIU Qiuping;ZHANG Minglu;LIU Xiaofei;KANG Jiali;SHEN Peng;LIN Hongbo;TANG Xun;GAO Pei(Department of Epidemiology and Biostatistics,Peking University School of Public Health,Beijing 100191,China;Yinzhou District Center for Disease Control and Prevention,Ningbo 315101,Zhejiang,China;Key Laboratory of Epidemiology of Major Diseases(Peking University),Ministry of Education,Beijing 100191,China;Center for Real-world Evidence Evaluation,Peking University Clinical Research Institute,Beijing 100191,China)

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [2]宁波市鄞州区疾病预防控制中心,浙江宁波315101 [3]重大疾病流行病学教育部重点实验室(北京大学),北京100191 [4]北京大学临床研究所真实世界证据评价中心,北京100191

出　　处：《北京大学学报（医学版）》2024年第3期441-447,共7页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(82373662、81973132);国家重点研发计划项目(2020YFC2003503)。

摘　　要：目的:在中国鄞州电子健康档案研究(Chinese electronic health records research in Yinzhou,CHERRY)的队列人群中,评价启动降压药物治疗的不同策略预防心血管病的健康收益与干预效率。方法:采用马尔科夫模型模拟评价的不同策略包括:策略1,对收缩压≥140 mmHg的人群启动降压药物治疗(根据2020年《中国心血管病一级预防指南》);策略2,对收缩压≥130 mmHg的人群启动降压药物治疗;策略3,对收缩压≥140 mmHg以及130~140 mmHg且心血管病高风险人群启动降压药物治疗(根据2017年美国心脏病学会/美国心脏协会《成年人高血压预防、检测、评估和管理指南》);策略4,对收缩压≥160 mmHg以及140~160 mmHg且心血管病高风险人群启动降压药物治疗(根据2019年英国国家卫生与临床优化研究所《成年人高血压诊断与管理指南》)。采用2019年世界卫生组织心血管病风险评估模型进行风险分层。马尔科夫模型的循环周期设为1年,模拟10个周期后计算质量调整生命年(quality-adjusted life year,QALY)、心血管病发病数、全因死亡数等结局事件数以评价策略的健康收益,并计算每预防一例心血管病事件或全因死亡的需治疗人数(number needed to treat,NNT)以评价策略的干预效率。马尔科夫模型的参数主要来源于CHERRY队列与公开发表的文献。采用单因素敏感性分析探讨心血管病发病率对结果的影响,采用概率敏感性分析探讨干预措施效应参数的不确定性对结果的影响。结果:共纳入213987名35~79岁基线无心血管病史的人群。相比于策略1,单纯下调降压起始值的策略2可预防的心血管病发病数增加666(95%UI:334~975)例,但每预防一例心血管病发病的NNT增加10(95%UI:7~20)人;而考虑定量风险评估的策略3可预防的心血管病发病数增加388(95%UI:194~569)例,且每预防一例心血管病发病的NNT减少6(95%UI:4~12)人,提示策略3可增加健康收益并具有更�Objective:To evaluate the health benefits and intervention efficiency of different strategies of initiating antihypertensive therapy for the primary prevention of cardiovascular diseases in a community-based Chinese population from the Chinese electronic health records research in Yinzhou(CHERRY)study.Methods:A decision-analytic Markov model was used to simulate and compare different antihypertensive initiation strategies,including:Strategy 1,initiation of antihypertensive therapy for Chinese adults with systolic blood pressure(SBP)≥140 mmHg(2020 Chinese guideline on the primary prevention of cardiovascular diseases);Strategy 2,initiation of antihypertensive therapy for Chinese adults with SBP≥130 mmHg;Strategy 3,initiation of antihypertensive therapy for Chinese adults with SBP≥140 mmHg,or with SBP between 130 and 140 mmHg and at high risk of cardiovascular diseases(2017 American College of Cardiology/American Heart Association guideline for the prevention,detection,evaluation,and management of high blood pressure in adults);Strategy 4,initiation of antihypertensive therapy for Chinese adults with SBP≥160 mmHg,or with SBP between 140 and 160 mmHg and at high risk of cardiovascular diseases(2019 United Kingdom National Institute for Health and Care Excellence guideline for the hypertension in adults:Diagnosis and management).The high 10-year cardiovascular risk was defined as the predicted risk over 10%based on the 2019 World Health Organization cardiovascular disease risk charts.Different strategies were simulated by the Markov model for ten years(cycles),with parameters mainly from the CHERRY study or published literature.After ten cycles of simulation,the numbers of quality-adjusted life years(QALY),cardiovascular events and all-cause deaths were calculated to evaluate the health benefits of each strategy,and the numbers needed to treat(NNT)for each cardiovascular event or all-cause death could be prevented were calculated to assess the intervention efficiency.One-way sensitivity analysis on the uncert

关 键 词：心血管病 一级预防 血压管理 马尔科夫模型 

分 类 号：R54[医药卫生—心血管疾病]