Treatment Intensification for Hypertension in US Ambulatory Medical Care.
Treatment Intensification for Hypertension in US Ambulatory Medical Care.
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DOI：
10.1161/jaha.116.004188
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发表时间：
2016-10-22
影响因子：
5.4
通讯作者：
Mukamal KJ
中科院分区：
文献类型：
--
作者：
Mu L;Mukamal KJ
高血压广泛流行，但在近一半的美国高血压成年人中仍不受控制。高血压强化治疗可降低主要心血管事件和全因死亡率，但临床惰性仍然是进一步改善高血压控制的显著障碍。本研究探讨了在美国门诊医疗护理中使用新药强化治疗的可能性和决定因素。使用具有全国代表性的全国门诊医疗调查（2005-2012年）和全国医院门诊医疗调查（2005-2011年），我们确定了诊断为高血压和记录血压超过目标目标的成人初级保健就诊，并评估了开始或添加新药物的治疗强化的加权患病率和比值比。在记录血压≥140/90 mm Hg的美国高血压成人中，每年约有4170万次初级保健就诊（粗N：14 064，2005-2012），其中强化治疗可能有益。然而，这些访视中只有700万（95%置信区间为620万-780万）接受了新药物强化治疗，加权患病率为16.8%（15.8%-17.9%）。这一比例一直很低，并随着时间的推移而下降。这一下降主要是由于既往未使用高血压药物的患者的药物起始水平从2007年的31.8%（26.0%至38.4%）下降至2012年的17.4%（14.0%至21.4%），而药物添加水平随着时间的推移保持更稳定。美国高血压成人仅在1/6的初级保健访视中接受了新药物强化治疗，这一比例随着时间的推移而下降。强化治疗的大幅增加仍然是最大限度地降低全国高血压相关发病率和死亡率的巨大机会。
Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care. Using the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time. US hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.