Outcomes improved with Canadian hypertension education program

加拿大高血压大众普及教育计划初显成效

       始于1999年的加拿大高血压教育计划（CHEP），旨在提高对高血压意识认识和加强治疗，此项计划已经表明可以减少心血管病住院和死亡。

       据所知，这项研究首次在统计学方面将全国范围内强化高血压治疗和心血管疾病减少相联系，也将临床预后的改善和全国性强化治疗高血压的开始相联系。特卡尔加里大学Norm Campbell和同事发表于《高血压杂志》。

       他们的研究证实了1996-2003年间，伴随着心血管病治疗结果标志性地改善，高血压处方药物应用实质性地增加，特别是在1999年CHEP开始之后。

       缺少“真实数据”能表明将临床试验数据转换为保健福利金可能是在全国范围内实行改善高血压和其他慢性疾病的一个障碍。

       Campbell的团队分析了加拿大人年标准死亡率和因心衰、急性心肌梗死（AMI）中风住院率，还有抗高血压治疗药物使用率之间的关系。

       基于通过各种全国范围内的数据统计，他们发现在1996-2003年间，每年总的抗高血压药物处方增加了84.4%，同时个体诊断为高血压的患者增加了65.1%，在此期间治疗的人数增加了77.0%。

       同时，心血管疾病有了实质性的减少，比1996年，在2003年因中风、心衰和急性心肌梗死死亡患者分别减少了833人、293人和3,559人。回归分析表明数量的下降与处方的增加有着密切关系（三组结果 P<0.0001）.时间序列分析表明中风、心衰和急性心肌梗死死亡率与1999年后与之前相比分别下降了3.0%, 4.3%和2.1%以上。

       相似结果在中风和心衰住院患者中也被发现，然而急性心梗入院患者年平均下降率1999年之前和之后是相似的。

       Campbell和他的团队总结道：“我们的分析结果证实了在加拿大人中高血压病治疗的迅速增加与心血管事件迅速而广泛地减少和CHEP的开始密切相关。

       世界卫生组织呼吁在全国范围内加强高血压管理防止心血管疾病的发生。

       美国北加利福尼亚，达勒姆，杜克大学罗伯特加利福发表相关评论，从流行病学数据角度看，平均而复杂、数量庞大的时间队列分析会出现不可预知的偏倚和混乱分析。

       vertheless写道“尽管有警告，但是这项分析证明大范围的执行医疗措施对整个国家的医疗负担有着重要的影响。

 source：www.Incirculation.net

《医心评论》编辑：呼唤 翻译  毛新罡 校对

Outcomes improved with Canadian hypertension education program

MedWire News: Study findings suggest that the Canadian Hypertension Education Program (CHEP), initiated in 1999 to raise awareness and treatment of hypertension, has resulted in reductions in hospitalizations and deaths due to cardiovascular disease.

“To our knowledge, this is the first study that has been able to statistically associate increased antihypertensive therapy with decreased cardiovascular disease on a national scale, and the improvement in outcomes with the start of a national effort to improve hypertension management,” report Norm Campbell (University of Calgary, Alberta, Canada) and colleagues in the journal Hypertension.

Their study confirmed a substantial increase in hypertensive medication prescriptions between 1996 and 2003, with marked improvements in cardiovascular outcomes over this period tied to the upswing in prescribing, particularly after the initiation of CHEP in 1999.

Noting that a lack of “real-world” data demonstrating that clinical trials data translate into health benefits may be a barrier to implementing national programs to improve hypertension and other chronic conditions, Campbell’s team analyzed the relationship between Canadian standardized yearly mortality and hospitalization rates for heart failure, acute myocardial infarction (AMI), and stroke and antihypertensive prescription rates.

Using various national databases, they found that total annual antihypertensive prescriptions increased by 84.4% between 1996 and 2003, while there was an estimated 65.1% increase in the number of individuals diagnosed with hypertension, and a 77.0% increase in the number treated, over this period.

Meanwhile, there were substantial reductions in cardiovascular outcomes, with 833, 293, and 3559 fewer total deaths from stroke, heart failure, and AMI in 2003 than in 1996. Regression analysis indicated that these reductions were significantly associated with the increase in prescriptions (p<0.0001 for all three outcomes). Time series analysis indicated that the yearly declines in mortality rates for stroke, heart failure, and AMI were respectively 3.0%, 4.3%, and 2.1% greater after 1999 compared with beforehand.

Similar results were found for hospitalization due to stroke and heart failure, whereas the annual rate of decline in AMI hospitalization was the same before and after 1999.

Campbell and team conclude: “Our analysis confirms that rapid increases in the treatment of hypertension in the Canadian population were closely associated with a rapid and extensive reduction in cardiovascular events and with the start of the CHEP.

Sults support calls by the World Health Organization to develop national programs to prevent cardiovascular disease through improved hypertension management.” an accompanying editorial, Robert Califf (Duke University, Durham, North Carolina, USA) acknowledges that even sophisticated and powerful time-series analyses of epidemiologic data are subject to “unpredictable biases and confounding.”

vertheless, he writes: “Despite these caveats, this analysis demonstrates that large-scale changes in the use of medications can have a significant effect on disease burden for an entire country.”