在管理式医疗人群中，降压药物的改变与血压目标的实现。

Antihypertensive medication changes and blood pressure goal achievement in a managed care population.

机构信息

i3 Innovus, Health Economics and Outcomes, Eden Prairie, MN 55344, USA.

出版信息

J Hum Hypertens. 2010 Oct;24(10):659-68. doi: 10.1038/jhh.2010.2. Epub 2010 Jan 28.

DOI:10.1038/jhh.2010.2

PMID:20107489

Abstract

This study examined achievement of blood pressure (BP) goals, changes in antihypertensive therapy and reasons for these changes among adults with hypertension initiating angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) or calcium channel blockers (CCBs). Claims data were examined for changes to medication regimens. Patient charts for 501 patients provided BP levels and reasons for changing medications. BP goal achievement was highest for initiators of ARBs (81.4%), compared with ACEIs (75.5%; P=NS) and CCBs (68.9%; P<0.01). Changes in antihypertensive therapy were least likely among ARB recipients (59.9%) compared with ACEIs (71.86%; P=0.02) and CCBs (74.85%; P<0.01). Failure to achieve BP goals was the most common reason for change in therapy (ARB, 32.9%; ACEI, 42.5%, P=NS; CCB, 47.9%, P<0.01). Although most patients achieved target BP goals, many required changes in treatment regimens. Initial choice of antihypertensive therapy may mitigate changes in therapies and better achieve BP goals.

摘要

本研究旨在考察起始应用血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体阻滞剂（ARB）或钙通道阻滞剂（CCB）的高血压患者的血压（BP）达标情况、降压治疗的变化及其原因。通过索赔数据来观察药物治疗方案的变化。501 名患者的病历提供了 BP 水平和药物更换的原因。ARB 起始治疗患者的 BP 达标率最高（81.4%），ACEI 为（75.5%；P=NS），CCB 为（68.9%；P<0.01）。与 ACEI（71.86%；P=0.02）和 CCB（74.85%；P<0.01）相比，ARB 患者最不可能改变降压治疗（59.9%）。未能达到 BP 目标是治疗改变的最常见原因（ARB 为 32.9%；ACEI 为 42.5%，P=NS；CCB 为 47.9%，P<0.01）。尽管大多数患者达到了目标 BP 目标，但许多患者需要改变治疗方案。初始降压治疗的选择可能会减轻治疗方案的变化，并更好地达到 BP 目标。