Steiner J F, Fihn S D, Blair B, Inut T S
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262.
J Clin Epidemiol. 1991;44(12):1361-71. doi: 10.1016/0895-4356(91)90097-s.
Physicians have traditionally viewed partial compliance with medications as a concern only in hypertensive patients whose blood pressure (BP) is poorly controlled. However, partial compliance also occurs in patients whose BP has become normal on medications; in them, reduced compliance may indicate that they have been prescribed more medication than they need. During enrollment for a study of medication reduction in hypertensive patients, we identified 118 male veterans who were eligible for the study because their diastolic BP had been less than 95 mmHg for more than 6 months. Fifty-nine of these patients (50.0%) agreed to participate in the study, of whom 71% successfully reduced or stopped ("stepped down") one or more of their antihypertensive drugs over a 1-year period. The 59 patients who did not enroll continued to receive routine care for hypertension in the clinic without intensive efforts at stepdown. Nevertheless, 24% of these patients reduced or stopped at least one medication over the same time period. In the year prior to the study, 29 of the 118 eligible patients (24.6%) had obtained less than 80% of their medications, measured by pharmacy refill records. Compliance in obtaining antihypertensive medications prior to the study was lower among eligible patients who stepped down medications during the study year (90.4% +/- 18.7%) than in those who did not (102.1% +/- 26.1%, p = 0.006). After adjustment for other predictors of stepdown (number of medications, duration of clinic enrollment, and pre-reduction systolic BP), each 10% increase in compliance among all eligible patients was associated with a reduction in the odds ratio for successful stepdown of 0.8 (95% CI 0.5-1.0, p = 0.01). We conclude that many well-controlled hypertensives appropriately obtain less medications than they are prescribed. Such patients should be considered for reduction of antihypertensive drugs.
传统上，医生认为只有血压控制不佳的高血压患者才需要关注药物治疗的部分依从性问题。然而，在服用药物后血压已恢复正常的患者中也会出现部分依从性的情况；对于这些患者，依从性降低可能表明他们所开的药物超过了实际需要。在一项关于高血压患者减药的研究招募过程中，我们确定了118名男性退伍军人符合研究条件，因为他们的舒张压低于95 mmHg已超过6个月。其中59名患者（50.0%）同意参与研究，在这59名患者中，71%在1年的时间里成功减少或停用（“逐步减量”）了一种或多种降压药物。未参与研究的59名患者在诊所继续接受高血压常规治疗，未进行强化的逐步减量治疗。尽管如此，在同一时期，这些患者中有24%减少或停用了至少一种药物。在研究前的一年中，根据药房配药记录，118名符合条件的患者中有29名（24.6%）获得的药物不足80%。在研究年度内进行药物逐步减量的符合条件患者中，研究前获取降压药物的依从性（90.4%±18.7%）低于未进行逐步减量的患者（102.1%±26.1%，p = 0.006）。在对逐步减量的其他预测因素（药物数量、诊所登记时间和减量前收缩压）进行调整后，所有符合条件患者的依从性每增加10%，成功逐步减量的比值比就降低0.8（95%可信区间0.5 - 1.0，p = 0.01）。我们得出结论，许多血压控制良好的高血压患者实际服用的药物比处方药物少是合理的。对于这类患者，应考虑减少降压药物的使用。
