MedMentis Consulting LLC, 145 Waughaw Rd, Towaco, NJ 07082, USA.
Cardiovasc Diabetol. 2010 Feb 1;9:7. doi: 10.1186/1475-2840-9-7.
This cross-sectional study sought to determine the prevalence of cardiometabolic risk factor clusters (CMRFCs) and their effect on BP control among hypertensive patients from 28 US physician practices.
Each participating practice identified a random sample of 150-300 adults aged >or= 18 years diagnosed with hypertension. The primary outcome variable was BP control (BP < 140/90 mmHg for non-diabetic and <130/80 mmHg for diabetic patients). CMRFCs included hypertension in addition to obesity, dyslipidemia, and diabetes.
Overall, 6,527 hypertensive patients were identified for study inclusion. More than half (54.3%) were female, and mean age was 64.7 years. Almost half (48.7%) were obese (BMI >or= 30 kg/m2). About 1 in every 4 patients (25.3%) had diabetes, and 60.7% had dyslipidemia. Mean blood pressure was 132.5/77.9 mmHg, and 55.0% of all patients had controlled BP; 62.4% of non-diabetic patients, and 33.3% of diabetic hypertensive patients, had BP controlled to recommended levels. Most (81.7%) hypertensive patients had >or= 1 cardiometabolic risk factor, and 12.2% had all 3 risk factors. As compared to hypertensive patients without additional risk factors, adjusted odds ratios for BP control were significantly lower for all combinations of CMRFCs (ORs 0.15-0.83, all p < 0.04), with the exception of patients who had only dyslipidemia in addition to hypertension (OR = 1.09, p = NS). Prescriber adherence to recommended hypertension treatment guidelines for patients with diabetes, heart failure, or prior myocardial infarction was high. Although patients with risk factors were prescribed more antihypertensive medications than those without, hypertensive patients with all 3 risk factors were prescribed a mean of 2.4 antihypertensive medications compared to 1.7 for those with no risk factors; odds of BP control in these patients, however, was 0.23 [95% CI 0.19-0.29] that of patients with no other CMRFCs.
Across 28 US practices, only 18% of hypertensive patients did not have any additional cardiometabolic risk factors. The high prevalence of CMRFCs presents a challenge to effective hypertension management.
本横断面研究旨在确定 28 家美国医生诊所中高血压患者中心血管代谢危险因素群（CMRFC）的流行情况及其对血压控制的影响。
每个参与的实践都确定了一个随机样本，其中包括 150-300 名年龄大于或等于 18 岁的成年人，这些成年人被诊断患有高血压。主要结局变量是血压控制（非糖尿病患者的血压<140/90mmHg，糖尿病患者的血压<130/80mmHg）。CMRFC 包括高血压，以及肥胖、血脂异常和糖尿病。
共有 6527 名高血压患者被确定为研究对象。超过一半（54.3%）为女性，平均年龄为 64.7 岁。将近一半（48.7%）的人肥胖（BMI≥30kg/m2）。约每 4 名患者（25.3%）患有糖尿病，60.7%的患者血脂异常。平均血压为 132.5/77.9mmHg，55.0%的患者血压得到控制；62.4%的非糖尿病患者和 33.3%的糖尿病高血压患者的血压控制在推荐水平。大多数（81.7%）高血压患者有≥1 种心血管代谢危险因素，12.2%的患者有 3 种危险因素。与无其他危险因素的高血压患者相比，所有 CMRFC 组合的血压控制调整比值比均显著降低（比值比 0.15-0.83，所有 p<0.04），仅高血压合并血脂异常的患者除外（比值比=1.09，p=NS）。对于有糖尿病、心力衰竭或既往心肌梗死的患者，医生对推荐的高血压治疗指南的遵循情况很高。尽管有危险因素的患者比没有危险因素的患者开了更多的降压药物，但有 3 种危险因素的高血压患者平均开了 2.4 种降压药物，而没有危险因素的患者开了 1.7 种降压药物；然而，这些患者的血压控制几率为 0.23[95%CI 0.19-0.29]，与没有其他 CMRFC 的患者相比。
在 28 家美国实践中，只有 18%的高血压患者没有任何其他心血管代谢危险因素。CMRFC 的高患病率对有效高血压管理构成了挑战。
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