Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA.
Ann Pharmacother. 2010 Jul-Aug;44(7-8):1164-70. doi: 10.1345/aph.1P034. Epub 2010 May 25.
Diabetes and hypertension can be challenging to manage in patients with mental health conditions. While the effectiveness of a cardiovascular risk reduction clinic (CRRC) has been shown not to differ between those with and without mental health conditions, it is unknown whether patients with mental health conditions would differ in durability of success following discharge from the CRRC.
To determine the effect of mental health conditions on the maintenance of glycemic control and blood pressure control in patients with diabetes following successful completion of a CRRC program.
Patients were discharged from the CRRC when therapeutic goals of hemoglobin A(1c) (A1C) <7% and blood pressure <130/80 mm Hg were achieved. We performed a retrospective chart review of a cohort of 231 patients by quarterly intervals for A1C and systolic blood pressure (SBP), providing up to 3 years of data following discharge from the CRRC. We assessed the time to failure to maintain goal A1C and SBP following CRRC discharge for patients with diagnosed mental health conditions versus patients without mental health conditions.
For patients with and without mental health conditions, 50% of those who had been discharged from the CRRC with an SBP goal of <130 mm Hg failed to maintain SBP by 1 quarter. The hazard ratio for failure to maintain SBP, with those without mental health conditions as the reference group, was 0.96 (95% CI 0.68 to 1.35). Overall, for patients with an A1C goal of <7%, the combined median time to failure was 3 quarters. Among patients without mental health conditions, 25% failed in 3 quarters, and of those with mental health conditions, 25% failed in 4 quarters (HR 0.91; 95% CI 0.50 to 1.66).
There was no significant difference between diabetic patients with and without mental health conditions in maintenance of A1C and SBP after discharge from a CRRC. This provides further evidence that a CRRC is a viable approach to cardiovascular risk reduction in individuals with mental health conditions.
对于患有心理健康问题的患者，糖尿病和高血压的管理具有挑战性。虽然已经证明心血管风险降低诊所（CRRC）的有效性在有和没有心理健康问题的患者之间没有差异，但尚不清楚心理健康问题患者在从 CRRC 出院后成功的持续时间上是否会有所不同。
确定心理健康问题对成功完成 CRRC 计划后糖尿病患者血糖控制和血压控制的维持效果。
当血红蛋白 A1c（A1C）<7%和血压<130/80mmHg 的治疗目标达到时，患者从 CRRC 出院。我们通过每季度间隔对 231 名患者的队列进行回顾性图表审查，提供了从 CRRC 出院后长达 3 年的数据。我们评估了在 CRRC 出院后，患有和未患有精神健康疾病的患者维持 A1C 和收缩压（SBP）目标的失败时间。
对于患有和未患有精神健康疾病的患者，50%的 SBP 目标<130mmHg 的患者在出院后一个季度内未能维持 SBP。没有精神健康疾病的患者与作为参考组的患者相比，SBP 失败的风险比为 0.96（95%CI 0.68 至 1.35）。总体而言，对于 A1C 目标<7%的患者，联合中位失败时间为 3 个季度。在没有精神健康疾病的患者中，25%的患者在 3 个季度内失败，而患有精神健康疾病的患者中，25%的患者在 4 个季度内失败（HR 0.91；95%CI 0.50 至 1.66）。
在从 CRRC 出院后，患有和未患有精神健康疾病的糖尿病患者在维持 A1C 和 SBP 方面没有显著差异。这进一步证明了 CRRC 是一种可行的降低心血管风险的方法，适用于患有精神健康疾病的个体。
