老年人抗高血压处方的偏好：一项离散选择实验
Preferences for Antihypertensive Prescribing in Older Adults: A Discrete Choice Experiment.
摘要(中文译文)
了解哪些因素会影响血压（BP）处方决策及其影响程度，可为减少老年人临床惰性的策略提供依据。本研究旨在探讨医生在决定对年龄≥65岁、血压未控制的成年人强化降压治疗时的偏好与权衡。我们针对澳大利亚医生开展了一项离散选择实验，呈现按年龄、衰弱、跌倒史、残余心血管风险及数字健康监测可用性变化的假设患者概况。医生需在2个收缩压目标之间选择：强化治疗（≤130 mm Hg）或标准治疗（131-150 mm Hg）。采用混合多项logit模型估计各属性效应，并采用潜在类别分析探讨偏好异质性。总体而言，医生偏好强化治疗目标（OR：2.70；95% CI：1.84-9.96），但该偏好随患者年龄增加（例如80岁；OR：0.05；95% CI：0.03-0.07）、近期跌倒（OR：0.22；95% CI：0.16-0.29）及中度衰弱（OR：0.24；95% CI：0.12-0.46）而降低。较高的残余心血管风险降低强化治疗的可能性，而数字健康可用性提高其可能性（OR：1.50；95% CI：1.05-2.15）。潜在类别分析识别出2组：风险容忍且数字参与型（64%），偏好强化治疗并对数字数据有反应；以及风险规避型（36%），无总体偏好且不受数字信息影响。临床医生对老年人强化降压治疗的决策受年龄、跌倒、衰弱、感知获益及数字监测数据可及性的影响。使用数字健康干预可能减少临床惰性，并应在临床试验中加以评估。
Abstract
Understanding which attributes influence blood pressure (BP) prescribing, and the magnitude of their effects, could inform strategies to reduce clinical inertia in older adults. The purpose of this study was to examine doctors' preferences and trade-offs when deciding to intensify antihypertensive treatment in adults aged ≥65 years with uncontrolled BP. We conducted a discrete choice experiment with Australian doctors, presenting hypothetical patient profiles varying by age, frailty, fall history, residual cardiovascular risk, and availability of digital health monitoring. Doctors chose between 2 systolic BP targets: intensive (≤130 mm Hg) or standard (131-150 mm Hg). A mixed multinomial logit model was used to estimate attribute effects, and latent class analysis to explore heterogeneity in preferences. Overall, doctors favored the intensive treatment target (OR: 2.70; 95% CI: 1.84-9.96) but this preference decreased with increasing patient age (eg, age 80; OR: 0.05; 95% CI: 0.03-0.07), recent falls (OR: 0.22; 95% CI: 0.16-0.29), and moderate frailty (OR: 0.24; 95% CI: 0.12-0.46). Higher residual cardiovascular risk reduced the likelihood of intensive treatment, whereas digital health availability increased it (OR: 1.50; 95% CI: 1.05-2.15). Latent class analysis identified 2 groups: risk tolerant, digitally engaged (64%), who preferred intensive treatment and were responsive to digital data, and risk-averse (36%), with no overall preference and were unaffected by digital information. Clinicians' decisions to intensify antihypertensive treatment in older adults are influenced by age, falls, frailty, perceived benefit, and access to digital monitoring data. Use of digital health interventions may reduce clinical inertia and should be evaluated in clinical trials.
如何引用
AMA
Edel O'Hagan, Ann Livingstone, Thomas Gadsden, Timothy Usherwood, Tu Nguyen, Aletta E Schutte, et al. Preferences for Antihypertensive Prescribing in Older Adults: A Discrete Choice Experiment.. Journal of the American College of Cardiology. 2026; doi:10.1016/j.jacc.2026.01.044.
APA
Edel O'Hagan, Ann Livingstone, Thomas Gadsden, Timothy Usherwood, Tu Nguyen, Aletta E Schutte, et al (2026). Preferences for Antihypertensive Prescribing in Older Adults: A Discrete Choice Experiment.. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2026.01.044
GB/T 7714
Edel O'Hagan, Ann Livingstone, Thomas Gadsden, Timothy Usherwood, Tu Nguyen, Aletta E Schutte, et al. Preferences for Antihypertensive Prescribing in Older Adults: A Discrete Choice Experiment.[J]. Journal of the American College of Cardiology, 2026 doi:10.1016/j.jacc.2026.01.044.
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