Filippi Alessandro, Bignamini Angelo Antonio, Sessa Emiliano, Samani Fabio, Mazzaglia Giampiero
Italian College of General Practitioners, University of Milan, Italy.
Stroke. 2003 Apr;34(4):1010-4. doi: 10.1161/01.STR.0000062888.90293.AA. Epub 2003 Mar 13.
Hypertension control and antiplatelet or oral anticoagulant drugs are the basis for secondary prevention of cerebrovascular events. Family physicians (FPs) are usually involved in both aspects of prevention, but no research has been carried out in Italy to evaluate the behavior of FPs in this field of prevention.
Data concerning 318 Italian FPs and 465,061 patients were extracted from the Health Search Database. Patients with coded diagnoses of stroke and transient ischemic attack (TIA) were selected. Demographic records and information regarding presence of concurrent disease and medical records were also obtained. Logistic regression analyses were carried out to assess whether conditions exist that make appropriate control of blood pressure (BP) and prescription of antiplatelet or anticoagulant drugs more likely.
We selected 2555 patients with diagnosis of stroke and 2755 with TIA. Among all of the subjects, 32.6% had no BP recorded. Among the remaining subjects, 58.7% reported uncontrolled BP. Isolated systolic hypertension has been shown in 68.8% of patients with uncontrolled BP. Antiplatelet and anticoagulant drugs were prescribed in 72% of these cases. Factors that made the prescription significantly more unlikely were diagnosis of TIA (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.41 to 0.54), total invalidity (OR, 0.66; 95% CI 0.56 to 0.78), and time from event of 5 years or more (OR, 0.81; 95% CI, 0.70 to 0.94).
Italian FPs could improve secondary prevention of cerebrovascular accidents. The primary target of intervention should be the control of systolic BP, and the group of patients with unacceptably high BP should be given priority. All of these patients should have been prescribed antiplatelet drugs or anticoagulant agents, except in cases of extremely short life expectancy or substantial contraindications.
高血压控制以及抗血小板或口服抗凝药物是脑血管事件二级预防的基础。家庭医生通常参与这两方面的预防工作，但意大利尚未开展研究来评估家庭医生在该预防领域的行为。
从健康搜索数据库中提取了318名意大利家庭医生和465,061名患者的数据。选取了诊断为中风和短暂性脑缺血发作（TIA）的患者。还获取了人口统计学记录以及关于并发疾病存在情况和病历的信息。进行逻辑回归分析以评估是否存在使血压（BP）得到适当控制以及抗血小板或抗凝药物处方更有可能的条件。
我们选取了2555名诊断为中风的患者和2755名TIA患者。在所有受试者中，32.6%没有记录血压。在其余受试者中，58.7%报告血压未得到控制。血压未得到控制的患者中68.8%表现为单纯收缩期高血压。这些病例中有72%开具了抗血小板和抗凝药物。使处方显著不太可能的因素包括TIA诊断（比值比[OR]，0.47；95%置信区间[CI]，0.41至0.54）、完全残疾（OR，0.66；95%CI，0.56至0.78）以及事件发生时间为5年或更长时间（OR，0.81；95%CI，0.70至0.94）。
意大利家庭医生可以改善脑血管意外的二级预防。干预的主要目标应该是控制收缩压，并且应优先关注血压过高而无法接受的患者群体。所有这些患者都应该开具抗血小板药物或抗凝剂，除非预期寿命极短或存在重大禁忌证。
