PREDISPOSING FACTORS FOR SEVERE, UNCONTROLLED HYPERTENSION IN AN INNER-CITY MINORITY POPULATION
PREDISPOSING FACTORS FOR SEVERE, UNCONTROLLED HYPERTENSION IN AN INNER-CITY MINORITY POPULATION
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DOI：
10.1056/nejm199209103271107
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发表时间：
1992-09-10
影响因子：
158.5
通讯作者：
FRANCIS, CK
中科院分区：
文献类型：
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作者：
SHEA, S;MISRA, D;FRANCIS, CK
背景高血压急症和紧急高血压是不受控制的高血压的最严重形式，现在主要见于贫困的少数民族人群。我们研究了这些情况下的患者接受的医疗护理的特点，以确定严重的，不受控制的高血压的危险因素。采用病例对照研究设计，我们采访了93例在医院急诊室就诊的严重、未控制的高血压患者和114例对照高血压患者;两组患者均于1989年至1991年在纽约市两家医院就诊。所有患者都是黑人或西班牙裔。多元逻辑回归模型用于调整年龄，性别，种族或民族背景，教育，吸烟状况，酒精相关的问题，并使用非法药物在前一年。在对缺乏健康保险进行额外调整后，发现严重的、不受控制的高血压在没有初级保健医生的患者中更常见（调整后的比值比，3.5; 95%置信区间，1.6至7.7）以及不遵守高血压治疗的患者（调整后的比值比，1.9; 95%置信区间，1.4至2.5）。在对缺乏初级保健医生和不依从抗高血压治疗进行调整后，缺乏健康保险与严重的、不受控制的高血压轻微相关（调整后的比值比为1.9; 95%置信区间为0.8 - 4.6）。没有初级保健医生和没有健康保险的患者更有可能在急诊室检查血压并接受血压药物处方，而不是在医生办公室或诊所。卫生保健系统和患者行为的特征与严重的、不受控制的高血压有关。通过健康保险或其他手段改善初级保健医生的使用，可能是改善弱势少数群体高血压控制的有效战略。
Background. Hypertensive emergency and urgent hypertension are the most severe forms of uncontrolled hypertension and are now seen predominantly in poor, minority populations. We studied the characteristics of the medical care received by patients with these conditions in order to identify risk factors for severe, uncontrolled hypertension.Methods. Using a case-control study design, we interviewed 93 patients with severe, uncontrolled hypertension who presented in the hospital emergency room and 114 control patients with hypertension; both groups were seen at two New York City hospitals from 1989 through 1991. All the patients were black or Hispanic. Multiple logistic-regression models were used to adjust for age, sex, race or ethnic background, education, smoking status, alcohol-related problems, and use of illicit drugs during the previous year.Results. After additional adjustment for lack of health insurance, severe, uncontrolled hypertension was found to be more common among patients who had no primary care physician (adjusted odds ratio, 3.5; 95 percent confidence interval, 1.6 to 7.7) and among those who did not comply with treatment for their hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 1.4 to 2.5). Lack of health insurance was marginally associated with severe, uncontrolled hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 0.8 to 4.6) after adjustment for lack of a primary care physician and noncompliance with antihypertensive treatment. Patients without a primary care physician and without health insurance were more likely to have their blood pressure checked and receive prescriptions for blood-pressure medications in emergency rooms than in physicians' offices or clinics.Conclusions. Characteristics of both the health care system and patients' behavior are associated with severe, uncontrolled hypertension. Improving access to primary care physicians, through health insurance or other means, may be an effective strategy for improving control of hypertension in disadvantaged minority populations.