Psaty Bruce M, Manolio Teri A, Smith Nicholas L, Heckbert Susan R, Gottdiener John S, Burke Gregory L, Weissfeld Joel, Enright Paul, Lumley Thomas, Powe Neil, Furberg Curt D
Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA.
Arch Intern Med. 2002 Nov 11;162(20):2325-32. doi: 10.1001/archinte.162.20.2325.
Control of high blood pressure (BP) in older adults is an important part of public health efforts at prevention.
To assess recent time trends in the awareness, treatment, and control of high BP and in the use of medications to treat high BP.
In the Cardiovascular Health Study, 5888 adults 65 years and older were recruited from 4 US centers. At baseline, participants underwent an extensive examination that included the measurement of BP, use of medications, and other risk factors. Participants were followed up with annual visits that assessed BP and medication use from baseline in 1989-1990 through the examination in 1998-1999. The primary outcome measures were control of BP to levels lower than than 140/90 mm Hg and the prevalence of use of various classes of antihypertensive medications.
The awareness, treatment, and control of high BP improved during the 1990s. The proportions aware and treated were higher among blacks than whites, though control prevalences were similar. For both groups combined, the control of high BP to lower than 140/90 mm Hg increased from 37% at baseline to 49% in 1999. The 51% whose BP was not controlled generally had isolated mild to moderate elevations in systolic BP. Among treated persons, the improvement in control was achieved in part by a mean increase of 0.2 antihypertensive medications per person over the course of 9 years. Improved control was also achieved by increasing the proportion of the entire Cardiovascular Health Study population that was treated for hypertension, from 34.5% in 1990 to 51.1% in 1999. Time trends in antihypertensive drug use were pronounced. Among those without coronary disease, the use of low-dose diuretics and beta-blockers decreased, while the use of newer agents, such as calcium channel blockers, angiotensin-converting enzyme inhibitors, and alpha-blockers increased.
While control of high BP improved in the 1990s, about half the participants with hypertension had uncontrolled BP, primarily mild to moderate elevations in systolic BP. Low-dose diuretics and beta-blockers--the preferred agents since 1993 according to the recommendations of the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure--remained underused. More widespread use of these agents will be an important intervention to prevent the devastating complications of hypertension, including stroke, myocardial infarction, and heart failure.
控制老年人的高血压是公共卫生预防工作的重要组成部分。
评估近期高血压知晓率、治疗率、控制率以及治疗高血压药物使用情况的时间趋势。
在心血管健康研究中，从美国4个中心招募了5888名65岁及以上的成年人。在基线时，参与者接受了全面检查，包括测量血压、药物使用情况及其他风险因素。对参与者进行年度随访，评估从1989 - 1990年基线期至1998 - 1999年检查期间的血压和药物使用情况。主要结局指标为血压控制在低于140/90 mmHg水平以及各类抗高血压药物的使用 prevalence。
20世纪90年代，高血压的知晓率、治疗率和控制率有所提高。黑人的知晓率和治疗率高于白人，不过控制率相似。两组综合来看，高血压控制在低于140/90 mmHg的比例从基线时的37%升至1999年的49%。血压未得到控制的51%的人一般只是单纯的轻度至中度收缩压升高。在接受治疗的人群中，控制情况的改善部分得益于在9年期间人均抗高血压药物平均增加了0.2种。通过增加整个心血管健康研究人群中接受高血压治疗的比例，从1990年的34.5%增至1999年的51.1%，也实现了更好的控制。抗高血压药物使用的时间趋势明显。在无冠心病的人群中，低剂量利尿剂和β受体阻滞剂的使用减少，而钙通道阻滞剂、血管紧张素转换酶抑制剂和α受体阻滞剂等新型药物的使用增加。
虽然20世纪90年代高血压控制情况有所改善，但约一半高血压患者的血压未得到控制，主要是轻度至中度收缩压升高。低剂量利尿剂和β受体阻滞剂——自1993年以来根据美国国家高血压检测、评估与治疗联合委员会的建议作为首选药物——仍未得到充分使用。更广泛地使用这些药物将是预防高血压灾难性并发症（包括中风、心肌梗死和心力衰竭）的一项重要干预措施。
