Episode Transcript
Announcer: 检查最新的研究，告诉你最新的突破. The Science and Research Show is on The Scope.
Interviewer: 将血压降至现行指南以下，对高危高血压患者的健康会产生重大影响. I'm talking with Dr. Brandon Bellows and Dr. 纳塔莉亚Ruiz-Negron,从犹他大学药学院的健康. What is the problem with high blood pressure?
High Blood Pressure
Dr. Bellows: Yeah, so high blood pressure is a major risk factor for cardiovascular diseases, and as blood pressure increases, there's a strong increased risk for having cardiovascular disease events, so things like heart attacks and strokes.
Interviewer: 在过去的几年里，有一项里程碑式的研究表明，稍微调整一下就能产生很大的影响.
SPRINT Trial
Dr. Bellows: Yes. So in the last, I guess this is about two years ago, the SPRINT study, the systolic blood pressure intervention trial, came out and it was looking at different systolic pressure goals. 因此，历史上的指南建议大多数成年人的目标收缩压低于140. So when you get your blood pressure taken, that's the top number. 这项研究关注的是心脏病发作和中风风险较高的住院病人, targeting a lower blood pressure goal of less than 120. 他们发现，在更密集的目标下，心血管疾病事件的风险和死亡率都显著降低.
Interviewer: 他们有一项持续了两年半的短期研究的结果?
Dr. Ruiz-Negron: It was meant to be extended out till five years, but because they did see such a favorable outcome, then they stopped it about halfway through.
Interviewer: But what wasn't known is the long-term effects?
Dr. Ruiz-Negron: Yes. That is correct. So that's where kind of modeling studies can come in. Using the short-term effects that we see, 大发娱乐可以尝试将其纳入一个模型，以评估长期影响，直到大发娱乐真正想要看到的任何时间框架, say 10 years, or in the case of an older adult, the lifetime just because of their age.
Interviewer: 当你看着这些长期的结果通过计算机建模, I mean, what were some of the things that you found?
Dr. Bellows: Because of the extrapolating, 三到五年数据一辈子有很多不确定性. We looked at different scenarios of what may happen to patients. 他们是继续服药，还是停止服药，等等. 但是大发娱乐发现不管患者是否在SPRINT研究的5年后继续坚持, that intensive blood pressure control, the less than 120 goal, 花费更多，但它提高了这些病人的存活率，而且它的价值是社会普遍愿意支付的，以延长生命.
Blood Pressure Medication
Interviewer: 所以Natalia，帮我理解一下这些不同的场景是什么样子的. I mean, 如果患者服药或不服药，会发生哪些事情?
Dr. Ruiz-Negron: To give you an example, 比如说五年之后这个人可能停止服药大发娱乐在药房说的一件大事就是如果大发娱乐不服药, then you don't achieve the blood pressures. So that's really important, and so if you don't achieve that less than 120 blood pressure, then the benefits of the systolic blood pressure target would go away.
So then during the first five years, 这个人有很好的机会降低他们经历这些并发症的风险, but then after the five years, because they stopped taking their medications, then that lowered risk would go away. 因此，从长远来看，较低的风险可能只是患心脏病的风险较低或患中风的风险较低.
Research Variables
Interviewer: Yeah. I mean, 我想提的一件事是你的不同模型中有很多变量因为现实生活中有很多可变性. Right? So I mean, what were some of these other things that were factored into your modeling, 你是如何决定哪些应该写进去，哪些应该删掉的呢?
Dr. Bellows: Yeah, that is a great question. So we had lots of different variables. 所以有很多因素会导致心血管疾病的风险所以大发娱乐试图抓住最重要的因素. 所以他们中的一些人的特征是从SPRINT试验中得来的. 因此，大发娱乐建立了一个与SPRINT试验相似的患者群体模型. So we got their cholesterol values, their kidney function, their blood pressures, all of that came from SPRINT.
大发娱乐在建模时做的另一件事是，大发娱乐从许多不同的来源获取变量, so published literature, 大型医学分析综合了许多不同的随机对照试验. So we pulled together all of these variables from one source or another, 大发娱乐所做的是咨询那些治疗高血压患者的医生，找出在这个模型中最重要的东西是什么，以试图预测他们的心血管疾病风险. 在那之后，大发娱乐建立了一个大发娱乐觉得不完全准确的模型. It's a simplification of reality, 但它涵盖了病人可能有的主要并发症和主要风险因素.
Interviewer: What can we do with this information? 现在你知道了它的好处大于风险，下一步是什么呢?
Monitoring Blood Pressure
Dr. Ruiz-Negron: That's a great question. So what we can do with this now, 现在大发娱乐知道强化血压对特定的病人来说是一种划算的选择, we can try to figure out how to best implement it in different settings. So there's outpatient settings that we can try and evaluate. 在医院系统中也有类似的东西. And so those are things that we're trying to work on next. 潜在地开发某种工具来识别那些将从这种干预中获益最多的患者，然后用这种工具向前推进，以便在这些环境中实施它，这样大发娱乐就可以大发娱乐提供最好的护理.
Dr. Bellows: 大发娱乐正在做的另一件事是研究如何在现有的医疗保健系统中实际实施这一方法. Do we need to hire more pharmacists and nurses, or do we need to buy more blood pressure monitoring devices? Do we need to send home blood pressure devices with patients? 因此，大发娱乐也在关注在医疗保健系统中实施这项技术的成本效益, both here locally as well as nationally.
Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio.