Ohta Y, Tsuchihashi T, Fujii K, Matsumura K, Ohya Y, Uezono K, Abe I, Iida M
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Hum Hypertens. 2004 Apr;18(4):273-8. doi: 10.1038/sj.jhh.1001666.
The objective of the study was to assess whether the publication of new guidelines, such as JNC VI 1997 and WHO/ISH 1999, and the development of new antihypertensive drugs have improved blood pressure (BP) control. A total of 150 patients (age 29-88, mean 66+/-11 years in 2001) who were followed at our hypertension clinic during 1991-2001 were retrospectively investigated. We compared the clinical characteristics of the patients in 2001 to those in 1991 and 1996, using the averaged BP determined at two occasions each year for our analysis. The average BP decreased during the 10 years between 1991 and 2001. When good BP control was defined as <140/90 mmHg, the rate of patients with good BP control increased from 31% in 1991 to 43% in 1996, and to 57% in 2001 (P<0.001 vs 1991). Both younger (< or =64 years) and older (> or =65 years) patients showed similar improvement during these 10 years. In 2001, satisfactory BP control (<130/85 mmHg) was achieved in 24% of younger patients, which was significantly higher than the achievement in 1991 (10%, P=0.02). This improvement occurred at the same time as an increase in the prescription of Ca antagonists and angiotensin II antagonist. The patients with improved BP control during these 10 years (n=50) showed lower body mass index (BMI) and serum total cholesterol levels in 2001 compared to persistently uncontrolled patients (n=54). Furthermore, the change in BMI during these 10 years was significantly less in the patients with improved BP control than in the persistently uncontrolled patients. In conclusion, BP control improved in the 10 years studied, and it seems to be attributable to the more frequent use of the newer drugs such as angiotensin II antagonists and Ca antagonists, to lifestyle modification and also to the growth in awareness of the importance of strict BP control.
本研究的目的是评估新指南（如1997年的《美国国家高血压教育计划第六次报告》和1999年的《世界卫生组织/国际高血压学会高血压治疗指南》）的发布以及新型抗高血压药物的研发是否改善了血压控制情况。对1991年至2001年期间在我们高血压诊所接受随访的150例患者（年龄29 - 88岁，2001年平均年龄66±11岁）进行了回顾性调查。我们将2001年患者的临床特征与1991年和1996年的患者进行了比较，分析时使用每年两次测量的平均血压。1991年至2001年的10年间平均血压有所下降。当将良好的血压控制定义为收缩压<140/舒张压<90 mmHg时，血压控制良好的患者比例从1991年的31%增加到1996年的43%，并在2001年增至57%（与1991年相比，P<0.001）。在这10年中，年龄较小（≤64岁）和年龄较大（≥65岁）的患者均有类似程度的改善。2001年，24%的年轻患者实现了满意的血压控制（收缩压<130/舒张压<85 mmHg），显著高于1991年的达标率（10%，P = 0.02）。这种改善与钙拮抗剂和血管紧张素II拮抗剂处方量的增加同时出现。与血压持续未得到控制的患者（n = 54）相比，在这10年中血压得到改善的患者（n = 50）在2001年的体重指数（BMI）和血清总胆固醇水平较低。此外，血压得到改善的患者在这10年中的BMI变化明显小于血压持续未得到控制的患者。总之，在研究的10年中血压控制情况有所改善，这似乎归因于血管紧张素II拮抗剂和钙拮抗剂等新型药物的更频繁使用、生活方式的改变以及对严格血压控制重要性认识的提高。
