Importance of therapy intensification and medication nonadherence for blood pressure control in patients with coronary disease
Importance of therapy intensification and medication nonadherence for blood pressure control in patients with coronary disease
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DOI：
10.1001/archinternmed.2007.72
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发表时间：
2008-02-11
影响因子：
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通讯作者：
Rumsfeld, John S.
中科院分区：
文献类型：
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作者：
Ho, P. Michael;Magid, David J.;Rumsfeld, John S.
背景资料：尽管在二级预防血压（BP）控制的重要性，一个显着比例的冠心病患者有不受控制的BP.Methods：这项回顾性队列研究的冠心病患者（N = 10 447）的药物治疗不依从性和治疗强化达到目标BP目标的影响进行了评估。药物依从性计算为已开具抗高血压药物处方的天数比例。治疗强化包括增加剂量或增加抗高血压药物的数量。主要结局是不受控制的收缩压（SBP）随时间的变化，使用潜在类模型，纳入纵向SBP数据，并将患者分配到SBP轨迹组。多变量回归分析评估了药物不依从性（即，所覆盖天数的比例，< 0.80）和治疗强化与SBP控制随时间的变化之间的关联，并对人口统计学和临床特征进行了调整。
Background: Despite the importance of blood pressure (BP) control in secondary prevention, a significant proportion of patients with coronary disease have uncontrolled BP.Methods: This retrospective cohort study of patients with coronary disease (N = 10 447) evaluated the impact of medication nonadherence and therapy intensification on reaching target BP goals. Medication adherence was calculated as the proportion of days covered for filled prescriptions of antihypertensive medications. Therapy intensification included dosage increase or increase in number of antihypertensive medications. The primary outcome was uncontrolled systolic BP (SBP) over time, using a latent class model that incorporated longitudinal SBP data and assigned patients to SBP trajectory groups. Multivariable regression evaluated the association between medication nonadherence ie, proportion of days covered, < 0.80) and therapy intensification with SBP control over time, with adjustment for demographics and clinical characteristics.Results: Three SBP trajectory groups were identified: (1) patients with BP that remained controlled (ie, SBP,