A SPECIFIC 3 MONTHS-PROGRAM TO IMPROVE NON-ADHERENCE IN UNCONTROLLED HYPERTENSION IMPROVES BLOOD PRESSURE CONTROL AND ASSOCIATED ORGAN DAMAGE (ATHAN CLINICAL TRIAL)
A SPECIFIC 3 MONTHS-PROGRAM TO IMPROVE NON-ADHERENCE IN UNCONTROLLED HYPERTENSION IMPROVES BLOOD PRESSURE CONTROL AND ASSOCIATED ORGAN DAMAGE (ATHAN CLINICAL TRIAL)
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旨在改善未受控制的高血压患者不依从性的具体 3 个月计划可改善血压控制和相关器官损伤（ATHAN 临床试验）
DOI：
10.1097/01.hjh.0000942288.44699.09
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发表时间：
2023
影响因子：
4.9
通讯作者：
S. Vázquez
中科院分区：
文献类型：
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作者：
A. Oliveras;Juanjo Hernández;Carme Camps;L. Fontdevila;Victoria Vega;E. Vinyoles;I. Galcerán;Marta Crespo;S. Vázquez
目的：评价一个特定的3个月（m）行动计划，以改善对dad 2药物治疗不受控制的高血压患者的治疗依从性，是否会导致血压下降，以及是否会维持在12个月。其次，评估这是否与亚临床器官损伤的改善相关。设计和方法：前瞻性、随机临床试验中，尽管接受了至少2种降压药物，但动态24 h-BP dad 130/80 mmHg在高血压病房连续就诊的患者，通过尿液中降压药物的测定证实了治疗不依从性，将患者随机（1：1）接受特定的3个月计划以改善依从性（INT =干预）或常规随访（C =对照）。未修改抗高血压治疗，但超过3个月的所有患者均接受常规护理。在随机分组前，以及3个月和12个月时，测定抗高血压药物和蛋白尿的尿液筛查，以及24小时动态血压监测。结果：46例患者被随机分组。在3个月时，24小时SBP和24小时DBP的平均（95%CI）基线校正BP差异（INT vs. C）分别为-14.7 mmHg（-5.4至-24.1），p = 0.001和-10.0 mmHg（-3.9至-16.2），p<0.001。INT组维持血压下降至12 m。与基线相比：24小时SBP的平均（95%CI）变异= -16.1 mmHg（-22.8至-9.4），p<0.001，24小时DBP的变异= -7.8（-12.8至-2.7），p = 0.002。在INT组中，未检测到的降压药物百分比较基线降低：中位[IQR]：基线、3个月和12个月时分别为40% [20-85.7]、0% [0-25]和18.3%[0-40]; 3个月和12个月时的变化分别为Z = -3.295（p<0.001）和Z = -3.055（p = 0.002）。INT组的白蛋白尿（中位数[IQR]）降低：基线和12个月时分别为27.1 mg/g [11.2-116.2]和22.4 mg/g [6.4-91.9]（Z =-2.207，p = 0.027）。在12个月时，尿蛋白的变化与24小时血压的变化相关，但与未检测到的抗高血压药物的百分比的变化无关。结论：一个3个月的特殊护理干预，以提高治疗依从性的结果改善血压控制的患者治疗依从性不足。这种改善将持续到该计划完成之后。血压下降与蛋白尿的消退相关。
Objective: To evaluate whether a specific 3-month(m) action plan to improve therapeutic adherence in patients with uncontrolled hypertension on ◊ 2 drugs results in a decrease in BP and whether this is maintained at 12m. Secondly, to assess if this correlates with an improvement in subclinical organ damage. Design and Method: Prospective, randomized clinical trial where patients attended consecutively in a Hypertension Unit with ambulatory 24h-BP ◊130/80 mmHg despite receiving at least 2 antihypertensive drugs and with therapeutic non-compliance confirmed by the determination of antihypertensive drugs in the urine, were randomized (1:1) to receive a specific 3-month program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified, but beyond 3m all patients received usual care. Before randomization, and at 3m and 12m, urinary screening for antihypertensive drugs and albuminuria, and 24h-ambulatory BP monitoring were determined. Results: Forty-six patients were randomized. At 3m, mean (95%CI) baseline-adjusted BP differences (INT vs. C) were -14.7 mmHg (-5.4 to -24.1), p = 0.001 and -10.0 mmHg (-3.9 to -16.2), p<0.001 for 24h-SBP and 24h-DBP, respectively. The INT group maintained the BP decrease at 12m. vs. baseline: mean(95%CI) variation of 24h-SBP = -16.1 mmHg (-22.8 to -9.4), p<0.001 and variation of 24h-DBP = -7.8 (-12.8 to -2.7), p = 0.002. In the INT group, the percentage of non-detected antihypertensive drugs decreased compared to baseline: median [IQR]: 40% [20-85.7], 0% [0-25], and 18.3 % [0-40] at baseline, 3m and 12m respectively; Z = -3.295 (p<0.001) and Z = -3.055 (p = 0.002) for changes at 3m and 12m, respectively. Albuminuria (median [IQR]) decreased in the INT group: 27.1 mg/g [11.2-116.2] and 22.4 mg/g [6.4-91.9] at baseline and 12m, respectively (Z = -2.207, p = 0.027). At 12m, variation of albuminuria correlated with variation of 24h-BP but not with variation of percentage of non-detected antihypertensive drugs. Conclusions: a 3-month specific nursing intervention to improve therapeutic adherence results in improved BP control in patients with inadequate therapeutic compliance. This improvement continues beyond the completion of this program. Decreased BP correlates with a regression of albuminuria.