Goal-Oriented Hypertension Management: Translating Clinical Trials to Practice
Goal-Oriented Hypertension Management: Translating Clinical Trials to Practice
复制标题
目标导向的高血压管理：将临床试验转化为实践
作者：
Gregory M. Singer;Munavvar Izhar;H. Black
摘要：几项使用血压（BP）治疗算法的临床试验集中在一个预定的目标上，取得了比全国调查数据更好的控制率。这些试验达到了第六届高血压预防、检测、评估和治疗联合国家委员会（JNC VI）90%志愿者舒张压（DBP）目标<90 mm Hg in >和60%志愿者收缩压（SBP）目标<140 mm Hg in >。我们评估了437例连续患者的血压控制，这些患者在一家采用“目标导向管理”的专科诊所至少随访一年后，即在没有正式药物治疗算法的情况下治疗特定的血压目标，以确定是否可以实现JNC VI目标。总体而言，276例（63%）患者达到SBP目标，376例（86%）达到DBP目标，358例（59%）达到两个目标。只有23%的患者接受单药治疗，34%的患者需要2种药物，37%的患者需要3种或更多种药物。年龄、性别和种族亚组之间的血压控制率没有实质性差异。然而，在20%的糖尿病患者中，只有52%的患者血压<140 mm Hg和<90 mm Hg，而更少的患者（分别为22%和15%）达到了JNC VI和美国糖尿病协会（ADA）/国家肾脏基金会（NKF）更严格的目标。目标导向的管理取得了显着更好的控制率比什么是报告。虽然DBP控制很容易实现，但达到SBP目标仍然很困难。采用目标导向管理可以将临床试验中取得的血压控制结果转化为门诊实践。
Abstract—Several clinical trials using a blood pressure (BP) treatment algorithm focused on a predetermined goal have achieved better control rates than those of national survey data. These trials reached the Sixth Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI) diastolic blood pressure (DBP) goal of <90 mm Hg in >90% of volunteers and systolic blood pressure (SBP) goal of <140 mm Hg in >60% of volunteers. We evaluated BP control of 437 consecutive patients after at least one year of follow up in a specialist clinic which employed “goal-oriented management,” ie, treating to a specific BP goal without a formal drug treatment algorithm, to determine whether JNC VI goals could be achieved. Overall, 276 (63%) patients achieved SBP goal, with 376 (86%) at DBP goal and 358 (59%) at both goals. Only 23% of patients were on monotherapy, with 34% requiring 2 drugs and 37% requiring 3 or more medications. There was no substantial difference in BP control rates among age, gender, and ethnicity subgroups. However, in the 20% of patients who were diabetic, only 52% had a BP of <140 mm Hg and <90 mm Hg, whereas fewer (22% and 15%, respectively) achieved the more stringent goals of JNC VI and the American Diabetic Association (ADA)/National Kidney Foundation (NKF). Goal-oriented management achieved dramatically better control rates than what is reported. Although DBP control was easy to achieve, achieving SBP goal still remained difficult. Employing goal-oriented management can translate BP control results achieved in clinical trials into outpatient practice.