Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high-risk clinical and ethnic groups with diabetes
Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high-risk clinical and ethnic groups with diabetes
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DOI：
10.1111/j.1525-1497.2004.30264.x
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发表时间：
2004-06-01
影响因子：
5.7
通讯作者：
Schneider, EC
中科院分区：
文献类型：
--
作者：
Rosen, AB;Karter, AJ;Schneider, EC
背景：45% 的终末期肾病 (ESRD) 是由糖尿病引起的。具有临床危险因素（白蛋白尿和高血压）的人和少数族裔（包括黑人、亚洲人和拉丁裔）的进展风险较高。血管紧张素转换酶抑制剂 (ACE) 和血管紧张素受体阻滞剂 (ARB) 可减缓糖尿病肾病的进展，但人们对它们在进展为 ESRD 高风险患者中的使用知之甚少。目的：检查 ACE 或 ARB (ACE/ARB) 的总体使用率以及高危临床适应症患者的使用率，并评估 ACE/ARB 使用的种族差异。设计：观察性队列研究。背景：北加州凯撒医疗机构 (KPNC) 糖尿病登记处是一个纵向登记处，用于监测所有 KPNC 糖尿病患者的护理质量和结果。患者：2000 年期间连续参加药物福利并在调查中拥有自我报告种族数据的糖尿病患者 (N= 38,887)。干预和测量：ACE/ARB 的药房配药。结果：该队列中 41% 的人同时患有高血压和蛋白尿，30% 的人仅患有高血压，12% 的人仅患有蛋白尿。 14% 是黑人，11% 是拉丁裔，13% 是亚裔，63% 是非拉丁裔白人。总体而言，61% 的患者接受了 ACE/ARB。 74% 的高血压和蛋白尿患者、64% 的单纯高血压患者和 54% 的单纯蛋白尿患者接受了 ACE/ARB 治疗。 61% 的白人、63% 的黑人、59% 的拉丁裔和 60% 的亚洲人获得了 ACE/ARB。在仅有蛋白尿的患者中，黑人接受 ACE/ARB 的可能性显着 (P = .0002) 低于白人（分别为 47% 和 56%）。未发现其他种族差异。结论：在该队列中，大多数符合条件的患者在 2000 年接受了指定的 ACE/ARB 治疗。然而，高达 45% 至 55% 的高风险临床群体（尤其是患有孤立性蛋白尿的个体）没有接受指定的治疗。增加 ACE/ARB 使用的额外有针对性的努力可以提高整体护理质量和降低高危族群的 ESRD 发病率。政策制定者可能会考虑使用 ACE/ARB 纳入糖尿病表现测量集。
BACKGROUND: Diabetes causes 45% of incident end-stage renal disease (ESRD). Risk of progression is higher in those with clinical risk factors (albuminuria and hypertension), and in ethnic minorities (including blacks, Asians, and Latinos). Angiotensin-converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) slow the progression of diabetic nephropathy, yet little is known about their use among patients at high risk for progression to ESRD.OBJECTIVES: To examine the prevalence of ACE or ARB (ACE/ARB) use overall and within patients with high-risk clinical indications, and to assess for ethnic disparities in ACE/ARB use.DESIGN: Observational cohort study.SETTING: Kaiser Permanente Northern California (KPNC) Diabetes Registry, a longitudinal registry that monitors quality and outcomes of care for all KPNC patients with diabetes.pATIENTS: Individuals (N= 38,887) with diabetes who were continuously enrolled with pharmacy benefits during the year 2000, and had self-reported ethnicity data on survey.INTERVENTIONS AND MEASUREMENTS: Pharmacy dispensing of ACE/ARB.RESULTS: Forty-one percent of the cohort had both hypertension and albuminuria, 30% had hypertension alone, and 12% had albuminuria alone. Fourteen percent were black, 11% Latino, 13% Asian, and 63% non-Latino white. Overall, 61% of the cohort received an ACE/ARB. ACE/ARB was dispensed to 74% of patients with both hypertension and albuminuria, 64% of those with hypertension alone, and 54% of those with albuminuria alone. ACE/ARB was dispensed to 61% of whites, 63% of blacks, 59% of Latinos, and 60% of Asians. Among those with albuminuria alone, blacks were significantly (P = .0002) less likely than whites to receive ACE/ARB (47% vs 56%, respectively). No other ethnic disparities were found.CONCLUSIONS: In this cohort, the majority of eligible patients received indicated ACE/ARB therapy in 2000. However, up to 45% to 55% of high-risk clinical groups (most notably individuals with isolated albuminuria) were not receiving indicated therapy. Additional targeted efforts to increase use of ACE/ARB could improve quality of care and reduce ESRD incidence, both overall and in high-risk ethnic groups. Policymakers might consider use of ACE/ARB for inclusion in diabetes performance measurement sets.