Petrella Robert J, Merikle Elizabeth
Faculty of Medicine and Dentistry, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
Clin Ther. 2008 Jun;30(6):1145-54. doi: 10.1016/j.clinthera.2008.06.004.
Previous evaluations of the Southwestern Ontario (SSWO) cohort have reported that hypertension (HTN) and dyslipidemia (DYS) are undertreated illnesses; however, concomitant treatment is unknown.
The objectives of this study were to assess the prevalence and associated treatment of HTN and DYS in primary health care in SWO and to identify care gaps across subpopulations.
In this retrospective cohort analysis, chart-abstracted medical records of patients aged>or=118 years with a clinical diagnosis of HTN, DYS, or both and the clinical practice records of primary health care facilities in London, Ontario, Canada, and the surrounding area were conducted between April and December 2000; longitudinal updates were performed quarterly until December 2004. Chart-abstracted information included demographics, lifestyle (eg, diet, exercise), cardiovascular disease indicators, complete morbidity profile, and drug treatments and effects.
The medical records of 46,322 patients who received medical care and the clinical practice records of 37 primary health care facilities (where the patients received treatment) in London, Ontario, Canada, and the surrounding area were included in this study. Our analyses found that the prevalence of HTN (17.66%) was greater than that of DYS (12.33%); with comorbid HTN and DYS found in 8.0% of the population. Most hypertensive patients were not dyslipidemic (54.88%), but more than half of dyslipidemic patients had comorbid HTN (64.99%). Significant differences in prevalence among the sex, age, and comorbid subgroups were found. HTN was higher among females than males (P<0.001) but lower among female smokers than male smokers (P<0.001). Patients aged >55 years were much more likely to be hypertensive, dyslipidemic, or both compared with those aged <55 years (P<0.009), except among those patients with a family history of coronary heart disease (CHD). Additionally, a steady increase in HTN and DYS prevalence with age by decade until 75 years of age, after which the rates dropped off, was observed. Most patients were untreated for HTN (66.00%) or DYS (80.00%) unless both conditions were present (35.00% untreated for HTN; 39.00% untreated for DYS). Among patients with comorbid HTN and DYS, the order of diagnosis had a significant effect on treatment level. The presence of other comorbidities (eg, family history of CHD) resulted in higher treatment and control rates. Control levels were generally poor, with 7.0% among patients with DYS, 15.00% among patients with HTN, and 17.00% among patients with both conditions.
Treatment patterns of HTN and DYS in practice settings are not in alignment with current guidelines in this cohort. Pharmacologic treatment of HTN and DYS is underprescribed. Patients most likely to receive treatment have comorbidities, but even in those high-risk groups, treatment levels are low and recommended control levels even lower.
先前对安大略西南部（SSWO）队列的评估报告称，高血压（HTN）和血脂异常（DYS）是治疗不足的疾病；然而，同时治疗情况尚不清楚。
本研究的目的是评估安大略西南部初级卫生保健中HTN和DYS的患病率及相关治疗情况，并确定各亚人群中的护理差距。
在这项回顾性队列分析中，对2000年4月至12月期间加拿大安大略省伦敦市及周边地区年龄≥18岁且临床诊断为HTN、DYS或两者皆有的患者的病历摘要以及初级卫生保健机构的临床实践记录进行了研究；每季度进行一次纵向更新，直至2004年12月。病历摘要信息包括人口统计学、生活方式（如饮食、运动）、心血管疾病指标、完整的发病情况以及药物治疗和效果。
本研究纳入了加拿大安大略省伦敦市及周边地区46322名接受医疗护理的患者的病历以及37家初级卫生保健机构（患者接受治疗的机构）的临床实践记录。我们的分析发现，HTN的患病率（17.66%）高于DYS（12.33%）；8.0%的人群同时患有HTN和DYS。大多数高血压患者没有血脂异常（54.88%），但超过一半的血脂异常患者合并有HTN（64.99%）。在性别、年龄和合并症亚组中发现患病率存在显著差异。女性HTN患病率高于男性（P<0.001），但女性吸烟者的HTN患病率低于男性吸烟者（P<0.001）。与年龄<55岁的患者相比，年龄>55岁的患者患HTN、DYS或两者皆有的可能性要高得多（P<0.009），冠心病（CHD）家族史患者除外。此外，观察到HTN和DYS患病率随年龄每十年稳步上升，直至75岁，之后患病率下降。大多数患者未接受HTN（66.00%）或DYS（80.00%）治疗，除非两种情况都存在（35.00%未接受HTN治疗；39.00%未接受DYS治疗）。在合并HTN和DYS的患者中，诊断顺序对治疗水平有显著影响。其他合并症（如CHD家族史）的存在导致更高的治疗和控制率。总体控制水平较差，DYS患者中为7.0%，HTN患者中为15.00%，两种情况都有的患者中为17.00%。
在本队列中，实际环境中HTN和DYS的治疗模式与当前指南不一致。HTN和DYS的药物治疗处方不足。最有可能接受治疗的患者患有合并症，但即使在这些高危人群中，治疗水平也较低，推荐的控制水平更低。
