Therapeutic inertia is an impediment to achieving the healthy people 2010 blood pressure control goals
Therapeutic inertia is an impediment to achieving the healthy people 2010 blood pressure control goals
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DOI：
10.1161/01.hyp.0000200702.76436.4b
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发表时间：
2006-03-01
期刊：
影响因子：
8.3
通讯作者：
Egan, BM
中科院分区：
文献类型：
--
作者：
Okonofua, EC;Simpson, KN;Egan, BM
治疗惰性 (TI) 定义为治疗目标未达到时，提供者未能增加治疗，导致不受控制的高血压 (>= 140/90 mm Hg) 患病率较高，但其定量影响尚不清楚。为了解决这一差距，我们对 7253 名高血压患者进行了一项回顾性队列研究，这些患者在 2003 年就诊次数 >= 4 次且血压 (BP) 升高 >= 1 次。计算每位患者的 1 年 TI 评分，作为预期和观察到的药物变化率之间的差异，得分越高，TI 越大。 13.1% 因血压未受控制而就诊的患者增加了抗高血压治疗。 TI 评分最低五分位数的患者收缩压下降，但最高五分位数的患者收缩压升高（- 6.8 +/- 0.5 对比 + 1.8 +/- 0.6 mm Hg；P < 0.001）。 TI 最低五分位数的个体在最后一次就诊时血压得到控制的可能性比最高五分位数的个体高出大约 33 倍（比值比，32.7；95% CI，25.1 至 42.6；P < 0.0001）。通过多变量分析，TI 约占血压控制方差的 19%。如果 TI 评分降低约 50%，即增加约 30% 的就诊次数，血压控制率将在 1 年内从观察到的 45.1% 增加到预计的 65.9%。这项研究证实了未控制的高血压受试者中 TI 发生率较高。 TI 对接受定期护理的高血压患者的血压控制有重大影响。降低 TI 对于实现“健康人 2010”控制 50% 患者高血压的目标至关重要。
Therapeutic inertia (TI), defined as the providers' failure to increase therapy when treatment goals are unmet, contributes to the high prevalence of uncontrolled hypertension ( >= 140/90 mm Hg), but the quantitative impact is unknown. To address this gap, a retrospective cohort study was conducted on 7253 hypertensives that had >= 4 visits and >= 1 elevated blood pressure ( BP) in 2003. A 1-year TI score was calculated for each patient as the difference between expected and observed medication change rates with higher scores reflecting greater TI. Antihypertensive therapy was increased on 13.1% of visits with uncontrolled BP. Systolic BP decreased in patients in the lowest quintile of the TI score but increased in those in the highest quintile ( - 6.8 +/- 0.5 versus + 1.8 +/- 0.6 mm Hg; P < 0.001). Individuals in the lowest TI quintile were approximate to 33 times more likely to have their BP controlled at the last visit than those in highest quintile ( odds ratio, 32.7; 95% CI, 25.1 to 42.6; P < 0.0001). By multivariable analysis, TI accounted for approximate to 19% of the variance in BP control. If TI scores were decreased approximate to 50%, that is, increasing medication dosages on approximate to 30% of visits, BP control would increase from the observed 45.1% to a projected 65.9% in 1 year. This study confirms the high rate of TI in uncontrolled hypertensive subjects. TI has a major impact on BP control in hypertensive subjects receiving regular care. Reducing TI is critical in attaining the Healthy People 2010 goal of controlling hypertension in 50% of all patients.