高血压治疗不足导致的高血压男性和女性中风过多。

Excess stroke among hypertensive men and women attributable to undertreatment of hypertension.

作者信息

Klungel O H, Stricker B H, Paes A H, Seidell J C, Bakker A, Voko Z, Breteler M M

机构信息

Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmacy, University of Utrecht, The Netherlands.

出版信息

Stroke. 1999 Jul;30(7):1312-8. doi: 10.1161/01.str.30.7.1312.

DOI:10.1161/01.str.30.7.1312

PMID:10390301

Abstract

BACKGROUND AND PURPOSE

Most population-based studies indicate that a considerable proportion of hypertensive subjects are undertreated and that undertreatment is more prevalent among hypertensive men than among hypertensive women. The aim of our study was to investigate the consequences of undertreatment of hypertension for women and men in terms of stroke occurrence.

METHODS

Approximately 45 000 men and women aged >/=20 years were examined in 2 population-based studies in the Netherlands. A cohort of 2616 hypertensive subjects (pharmacologically treated hypertensives and untreated hypertensives who needed pharmacological treatment according to the severity of their hypertension and the coexistence of additional cardiovascular risk factors) was selected for a follow-up study. Follow-up (mean duration, 4.6 years) was complete for 2369 (91%) of the enrolled hypertensive subjects.

RESULTS

Compared with treated and controlled hypertensives, the relative risks of stroke for treated and uncontrolled hypertensives and for untreated hypertensives who needed treatment were 1.30 (95% CI, 0.70 to 2.44) and 1.76 (95% CI, 1.05 to 2.94), respectively. These relative risks and the prevalence of (undertreated) hypertension in the total population of 45 000 subjects were used to estimate the number of strokes in the Netherlands attributable to undertreatment. Among hypertensive men and women aged >/=20 years in the Netherlands, the proportions of strokes attributable to treated but uncontrolled blood pressure were 3.1% (95% CI, -5.2% to 18.7%) and 4.1% (95% CI, -7.2% to 20.7%), respectively. For untreated hypertensive men and women who should have been treated, these proportions were 22.8% (95% CI, 0.8% to 38.4%) and 25.4% (95% CI, 0. 5% to 42.5%), respectively.

CONCLUSIONS

Increasing the detection of hypertension and improving adherence to current guidelines might prevent a considerable proportion of the incident strokes among hypertensives. The potential impact of achieving control of blood pressure in patients already being treated on the reduction of strokes requires further investigation.

摘要

背景与目的

大多数基于人群的研究表明，相当一部分高血压患者治疗不足，且男性高血压患者治疗不足的情况比女性更为普遍。我们研究的目的是从卒中发生的角度调查高血压治疗不足对男性和女性的影响。

方法

在荷兰的两项基于人群的研究中，对约45000名年龄≥20岁的男性和女性进行了检查。从这些人群中选取了2616名高血压患者（接受药物治疗的高血压患者以及根据高血压严重程度和其他心血管危险因素共存情况需要药物治疗的未治疗高血压患者）组成队列进行随访研究。2369名（91%）登记的高血压患者完成了随访（平均持续时间4.6年）。

结果

与接受治疗且血压得到控制的高血压患者相比，接受治疗但血压未得到控制的高血压患者以及需要治疗但未治疗的高血压患者发生卒中的相对风险分别为1.30（95%CI，0.70至2.44）和1.76（95%CI，1.05至2.94）。利用这些相对风险以及45000名受试者总体人群中（治疗不足的）高血压患病率来估计荷兰因治疗不足导致的卒中数量。在荷兰年龄≥20岁的高血压男性和女性中，因治疗但血压未得到控制导致的卒中比例分别为3.1%（95%CI，-5.2%至18.7%）和4.1%（95%CI，-7.2%至20.7%）。对于本应接受治疗但未治疗的高血压男性和女性，这些比例分别为22.8%（95%CI，0.8%至38.4%）和25.4%（95%CI，0.5%至42.5%）。