Generic medications and blood pressure control in diabetic hypertensive subjects: results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
Generic medications and blood pressure control in diabetic hypertensive subjects: results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
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DOI：
10.2337/dc12-0755
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发表时间：
2013-03
期刊：
影响因子：
16.2
通讯作者：
Muntner P
中科院分区：
文献类型：
--
作者：
Cummings DM;Letter AJ;Howard G;Howard VJ;Safford MM;Prince V;Muntner P
研究糖尿病受试者血压（BP）控制的时间改善和关于非专利抗高血压药物的政策变化。在一项横断面研究中，我们使用逻辑回归模型来调查获得非专利抗高血压药物和血压控制之间的时间关系（<130/80 mmHg），5，375例受试者平均年龄66 ± 9岁; 61%的非裔美国人），糖尿病和高血压（HTN）患者入选了卒中地理和种族差异原因（REGARDS）的国家结果2003年至2007年的队列研究。在登记时，测量血压，并由受过训练的专业人员通过药物标签审查确定家中的药物。从美国食品药品监督管理局确定了通用抗高血压药物治疗状态。使用通用抗高血压药物的受试者比例从2003年的66%显著增加至2007年的81%（P < 0.0001），2007年达到BP <130/80 mmHg的比值比2003年高66%（比值比1.66 [95%CI 1.30-2.10]）。然而，<50%的参与者实现了这一目标。非裔美国人种族、男性、有限的收入和药物不依从性是血压控制不足的重要预测因素。当模型中包括其他人口统计学因素时，使用非专利抗高血压药物与血压控制之间没有显著关系（0.98 [0.96-1.00]）。在患有HTN和糖尿病的非裔美国人和白色受试者中，相对于已发表的指南，BP控制仍然不足，种族差异仍然存在。虽然使用非专利抗高血压药物的机会增加，但这与血压控制改善并不独立相关，表明血压控制不良是多因素的。
To investigate temporal improvements in blood pressure (BP) control in subjects with diabetes and policy changes regarding generic antihypertensives. In a cross-sectional study we used logistic regression models to investigate the temporal relationship between access to generic antihypertensive medications and BP control (<130/80 mmHg) in 5,375 subjects (mean age, 66 ± 9 years; 61% African American) with diabetes and hypertension (HTN) enrolled in the national Results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study between 2003 and 2007. At enrollment, BP was measured and medications in the home determined by medication label review by a trained professional. Generic antihypertensive medication status was ascertained from the U.S. Food and Drug Administration. The percentage of subjects accessing generically available antihypertensive medications increased significantly from 66% in 2003 to 81% in 2007 (P < 0.0001), and the odds of achieving a BP <130/80 mmHg in 2007 was 66% higher (odds ratio 1.66 [95% CI 1.30–2.10]) than in 2003. Nevertheless, <50% of participants achieved this goal. African American race, male sex, limited income, and medication nonadherence were significant predictors of inadequate BP control. There was no significant relationship between access to generic antihypertensives and BP control when other demographic factors were included in the model (0.98 [0.96–1.00]). Among African American and white subjects with HTN and diabetes, BP control remained inadequate relative to published guidelines, and racial disparities persisted. Although access to generic antihypertensives increased, this was not independently associated with improved BP control, suggesting that poor BP control is multifactorial.