Keyhani Salomeh, Scobie Janice V, Hebert Paul L, McLaughlin Mary Ann
Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, NY, USA.
Hypertension. 2008 Apr;51(4):1149-55. doi: 10.1161/HYPERTENSIONAHA.107.107342. Epub 2008 Feb 7.
The purpose of this study was to provide an analysis of gender-based disparities in hypertension and cardiovascular disease care in ambulatory practices across the United States. Using data from the 2005 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, we conducted a cross-sectional analysis of patient visits with their primary care providers and examined the association between gender and blood pressure control, use of any antihypertensive medication or initiation of new therapy for patients with uncontrolled hypertension, and receipt of recommended therapy for select cardiovascular conditions. Multivariable models were estimated to examine the association between gender and each outcome controlling for other variables. A total of 12 064 patient visits were identified (7786 women and 4278 men). Among patients with hypertension, women were less likely than men to meet blood pressure control targets (54.0% versus 58.7%; P<0.02). In multivariate analyses, women aged 65 to 80 years were less likely than men to have controlled hypertension (odds ratio: 0.62; 95% CI: 0.45 to 0.85). There was no association between gender and use of any antihypertensive medication or initiating a new therapy among patients with uncontrolled hypertension. In multivariate analyses, women were less likely than men to receive aspirin (odds ratio: 0.43; 95% CI: 0.27 to 0.67) and beta-blockers (odds ratio: 0.60; 95% CI: 0.36 to 0.99) for secondary prevention of cardiovascular disease. Our study highlights the persistent gender disparities in blood pressure control and cardiovascular disease management and also reveals the inadequate delivery of cardiovascular care to all patients.
本研究的目的是分析美国门诊医疗中高血压和心血管疾病护理方面基于性别的差异。利用2005年国家门诊医疗调查和国家医院门诊医疗调查的数据，我们对患者与初级保健提供者的就诊情况进行了横断面分析，并研究了性别与血压控制、使用任何抗高血压药物或为未控制高血压患者启动新治疗以及接受特定心血管疾病推荐治疗之间的关联。估计多变量模型以检验性别与控制其他变量后的每个结果之间的关联。共确定了12064次患者就诊（7786名女性和4278名男性）。在高血压患者中，女性达到血压控制目标的可能性低于男性（54.0%对58.7%；P<0.02）。在多变量分析中，65至80岁的女性高血压得到控制的可能性低于男性（比值比：0.62；95%置信区间：0.45至0.85）。在未控制高血压的患者中，性别与使用任何抗高血压药物或启动新治疗之间没有关联。在多变量分析中，女性接受阿司匹林（比值比：0.43；95%置信区间：0.27至0.67）和β受体阻滞剂（比值比：0.60；95%置信区间：0.36至0.99）进行心血管疾病二级预防的可能性低于男性。我们的研究突出了血压控制和心血管疾病管理中持续存在的性别差异，也揭示了对所有患者心血管护理的提供不足。
