[血压未控制的高血压患者的心血管风险状况。Control-Project研究]

[Cardiovascular risk profile of uncontrolled hypertensive patients. The Control-Project study].

作者信息

Márquez-Contreras Emilio, Coca Antonio, de la Figuera von Wichmann Mariano, Divisón Juan Antonio, Llisterri José Luis, Sobrino Javier, Filozof Claudia, Sánchez-Zamorano Miguel Angel, Grigorian Shamagian Lilian

机构信息

Centro de Salud la Orden, Huelva, Spain.

出版信息

Med Clin (Barc). 2007 Jan 27;128(3):86-91. doi: 10.1016/s0025-7753(07)72498-3.

DOI:10.1016/s0025-7753(07)72498-3

PMID:17288921

Abstract

BACKGROUND AND OBJECTIVE

To assess absolute cardiovascular risk and co-morbidities in uncontrolled hypertensive patients (blood pressure [BP]>or=140/90 mmHg or>or=130/80 mmHg in diabetics) attending Primary Care Physicians in Spain, and to determine the attitudes of these physicians towards this problem.

PATIENTS AND METHOD

Cross-sectional, multicenter study involving 356 general practitioners around Spain. Absolute cardiovascular risk was assessed according to ESH-ESC 2003 Guidelines in a sample of 1,710 patients.

RESULTS

Two hundred ninety seven patients were excluded by several reasons and a total of 1,413 hypertensive patients were valuable (mean age: 65.3+/-11.4 years; 56.7% women). Normal BP values (<140/90 mmHg) were exhibited by 0.2%, high-normal BP (120-139/80-89 mmHg) were exhibited by 2.8%, grade 1 hypertension (140-159/90-99 mmHg) by 49.9%, grade 2 hypertension (160-179/100-109 mmHg) by 39.3%, and grade 3 hypertension (>or=180/110 mmHg) by 7.9%. Associated cardiovascular risk factors were observed in 96.0% of patients (95% CI=94.7-97.2%), target organ damage in 34.5% (95% CI=31.6-36.5%), and cardiovascular clinical disease in 36.0% (95% CI=33.5-38.5%). According to ESH-ESC 2003 Guidelines 34.0% (CI=31.5-38.2%) were at very-high risk; 29.4% (95% CI=26.4-32.8%) at high risk; 30.4% (95% CI=27.2-33.7%) at moderate risk and 5.4% (95% CI=3.9-7.2%) at low risk of cardiovascular disease. Despite the high absolute risk, physicians did not do any therapeutic change in 30.4% (95% CI=28.2-33.5%) of uncontrolled hypertensive patients. Most of them (64.26%) considered that bad compliance to life style changes was the reason for inadequate BP control. The most frequent measure introduced was the association of additional drugs.

CONCLUSIONS

Absolute cardiovascular risk in uncontrolled hypertensive patients attending Primary Care Physicians in Spain is very relevant. Sixty-five percent of these patients are at high or very high risk with a high prevalence of target organ damage or associated cardiovascular clinical disease. Therapeutic attitudes towards these patients are still very conservative although they are improving compared with previous studies.

摘要

背景与目的

评估西班牙基层医疗医生所诊治的血压未得到控制的高血压患者（糖尿病患者血压≥140/90 mmHg或≥130/80 mmHg）的绝对心血管风险及合并症，并确定这些医生对该问题的态度。

患者与方法

一项横断面、多中心研究，涉及西班牙各地356名全科医生。根据欧洲高血压学会（ESH）-欧洲心脏病学会（ESC）2003年指南，对1710例患者样本进行绝对心血管风险评估。

结果

因多种原因排除297例患者，共1413例高血压患者纳入研究（平均年龄：65.3±11.4岁；56.7%为女性）。血压正常（<140/90 mmHg）者占0.2%，血压正常高值（120 - 139/80 - 89 mmHg）者占2.8%，1级高血压（140 - 159/90 - 99 mmHg）者占49.9%，2级高血压（160 - 179/100 - 109 mmHg）者占39.3%，3级高血压（≥180/110 mmHg）者占7.9%。96.0%的患者存在相关心血管危险因素（95%可信区间[CI]=94.7 - 97.2%），34.5%的患者存在靶器官损害（95% CI=31.6 - 36.5%），36.0%的患者存在心血管临床疾病（95% CI=33.5 - 38.5%）。根据ESH - ESC 2003年指南，34.0%（CI=31.5 - 38.2%）患者处于极高风险；29.4%（95% CI=26.4 - 32.8%）患者处于高风险；30.4%（95% CI=27.2 - 33.7%）患者处于中度风险；5.4%（95% CI=3.9 - 7.2%）患者处于低心血管疾病风险。尽管绝对风险高，但30.4%（95% CI=28.2 - 33.5%）血压未得到控制的高血压患者，医生未进行任何治疗调整。其中大多数（64.26%）认为患者对生活方式改变依从性差是血压控制不佳的原因。最常采取的措施是加用其他药物。