教学机构中高血压管理对美国国家联合委员会第7版指南的依从性
Compliance with Joint National Committee 7 guidelines in hypertension management in a teaching institution.
作者信息
Jami Prasuna, Smith Pamela, Moningi Shalini, Moningi Venkata, Martin Shelda A, Rosencrance Gregory, Reyes Bernardo J
机构信息
Department of Internal Medicine, West Virginia University, Charleston, USA.
出版信息
Am J Med Qual. 2007 Jul-Aug;22(4):251-8. doi: 10.1177/1062860607303293.
AIM
To assess compliance with Joint National Committee 7 (JNC 7) guidelines and evaluate target blood pressure (BP) goals among patients with hypertension.
RESULTS
Basic laboratory workup was completed on 75% of patients, and 71% received smoking cessation counseling. Overall BP goal achievement was 45.6%; it was 27.6% and 21.1% among diabetes and chronic kidney disease (CKD) patients, respectively. An average of 2.6 antihypertensive medications were prescribed per patient, with beta-blockers being the most frequently used, followed by thiazide diuretics and angiotensin-converting enzyme inhibitors (ACEIS). ACEIS or angiotensin receptor blockers (ARBs) were not prescribed for 16% of diabetics, 26% of chronic renal failure patients, or 41% of those with history of stroke. Among heart failure patients, 24.1% were not on ACEI or ARBs, and 20.7% were not receiving beta-blockers.
CONCLUSIONS
Certain aspects of JNC 7 are not well incorporated into clinical practice, especially among patients with coexisting diabetes and/or CKD.
目的
评估对美国国家联合委员会第7版（JNC 7）指南的遵循情况，并评估高血压患者的目标血压（BP）达标情况。
结果
75%的患者完成了基本实验室检查，71%的患者接受了戒烟咨询。总体血压目标达标率为45.6%；糖尿病患者和慢性肾脏病（CKD）患者的达标率分别为27.6%和21.1%。每位患者平均开具2.6种抗高血压药物，其中β受体阻滞剂使用最为频繁，其次是噻嗪类利尿剂和血管紧张素转换酶抑制剂（ACEIs）。16%的糖尿病患者、26%的慢性肾衰竭患者或41%有卒中病史的患者未开具ACEIs或血管紧张素受体阻滞剂（ARBs）。在心力衰竭患者中，24.1%未使用ACEI或ARB，20.7%未接受β受体阻滞剂治疗。
结论
JNC 7的某些方面未很好地纳入临床实践，尤其是在合并糖尿病和/或CKD的患者中。
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