The association between medication adherence and treatment intensification with blood pressure control in resistant hypertension.
The association between medication adherence and treatment intensification with blood pressure control in resistant hypertension.
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DOI：
10.1161/hypertensionaha.112.192096
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Ho PM
中科院分区：
文献类型：
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作者：
Daugherty SL;Powers JD;Magid DJ;Masoudi FA;Margolis KL;O'Connor PJ;Schmittdiel JA;Ho PM
顽固性高血压患者面临预后不良的风险。药物依从性和强化治疗可改善血压控制；然而，人们对这些过程或其与难治性高血压结果的关联知之甚少。这项回顾性研究纳入了 2002 年至 2006 年期间来自两个卫生系统的高血压患者，这些患者出现了难治性高血压，或者尽管坚持使用 ≥ 3 种抗高血压药物，但血压仍不受控制。高血压治疗模式、药物依从性（覆盖天数的百分比）和治疗强化（药物类别或剂量的增加）在顽固性高血压识别后的一年内进行了描述。然后，根据患者特征，评估药物依从性和强化治疗与一年血压控制之间的关联。在 3,550 名难治性高血压患者中，49% 为男性，平均年龄 60 岁。在确定难治性高血压一年后，服用利尿剂（77.7% vs. 92.2%，p<0.01）、β 受体阻滞剂（71.2% vs. 79.4%，p<0.01）和 ACE/ARB（64.8% vs. 70.1%，p<0.01）的患者较少到基线。血压控制率在一年内得到改善（22% vs. 55%，p=<0.01）。在这一年中，依从性与 1 年血压控制无关（调整后 OR 1.18，0.94-1.47）。 21.6% 的就诊患者因血压升高而加强治疗。增加治疗强度与 1 年血压控制相关（调整后 OR 1.64；95% CI 1.58-1.71）。在这组难治性高血压患者中，治疗强化而非药物依从性与一年血压控制显着相关。这些发现强调需要调查为什么血压不受控制的患者没有接受强化治疗。
Patients with resistant hypertension are at risk for poor outcomes. Medication adherence and intensification improve blood pressure control; however, little is known about these processes or their association with outcomes in resistant hypertension. This retrospective study included patients from 2002-2006 with incident hypertension from two health systems who developed resistant hypertension, or uncontrolled blood pressure despite adherence to ≥3 antihypertensive medications. Patterns of hypertension treatment, medication adherence (percentage of days covered) and treatment intensification (increase in medication class or dose) were described in the year after resistant hypertension identification. Then, the association between medication adherence and intensification with 1-year blood pressure control was assessed controlling for patient characteristics. Of the 3,550 patients with resistant hypertension, 49% were male and mean age 60. One year after resistance hypertension determination, fewer patients were taking diuretics (77.7% vs. 92.2%, p<0.01), beta blockers (71.2% vs. 79.4%, p<0.01) and ACE/ARB (64.8% vs. 70.1%, p<0.01) compared to baseline. Rates of blood pressure control improved over 1-year (22% vs. 55%, p=<0.01). During this year, adherence was not associated with 1-year blood pressure control (adjusted OR 1.18, 0.94-1.47). Treatment was intensified in 21.6% of visits with elevated blood pressure. Increasing treatment intensity was associated with 1-year blood pressure control (adjusted OR 1.64; 95% CI 1.58-1.71). In this cohort of patients with resistant hypertension, treatment intensification but not medication adherence was significantly associated with 1-year blood pressure control. These findings highlight the need to investigate why patients with uncontrolled blood pressure do not receive treatment intensification.