Veronesi Maddalena, Cicero Arrigo F G, Prandin Maria Grazia, Dormi Ada, Cosentino Eugenio, Strocchi Enrico, Borghi Claudio
D. Campanacci Clinical Medicine and Applied Biotechnology Department, Alma Mater Studiorum University of Bologna, Italy.
Vasc Health Risk Manag. 2007;3(6):999-1005.
Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.
坚持治疗会影响降压治疗的疗效。我们前瞻性地调查了347例高血压患者（年龄59.4±6岁）的治疗依从性和血压（BP）控制程度，这些患者被随机分配接受一线治疗：血管紧张素转换酶（ACE）抑制剂、钙通道阻滞剂（CCB）、β受体阻滞剂、血管紧张素II受体阻滞剂（ARB）或利尿剂，并随访24个月。与CCB（51.6%；p<0.05）、β受体阻滞剂（44.8%，p<0.05）和利尿剂（34.4%，p<0.01）相比，接受ARB（68.5%）和ACE抑制剂（64.5%）治疗的患者治疗依从性更高。与各治疗类别中使用的其他分子相比，没有一种ARB、ACE抑制剂、β受体阻滞剂或利尿剂与更高的治疗依从性相关。与其他CCB相比，接受乐卡地平治疗的患者的持续率显著更高（59.3%对46.6%，p<0.05）。与β受体阻滞剂（-4.0/-2.3 mmHg，p<0.05）和利尿剂（-2.3/-2.1 mmHg，p<0.05）相比，接受ARB（-11.2/-5.8 mmHg）、ACE抑制剂（-10.5/-5.1 mmHg）和CCB（-8.5/-4.6 mmHg）治疗的患者收缩压和舒张压下降更成功。与各治疗类别中使用的其他分子相比，没有一种ARB、ACE抑制剂、β受体阻滞剂或利尿剂与更好的血压控制相关。与其他CCB相比，乐卡地平治疗后观察到血压控制有更好的趋势（p=0.059）。目前的结果证实了坚持治疗在临床实践中管理高血压的重要性。
