Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
BMC Health Serv Res. 2010 Dec 30;10:349. doi: 10.1186/1472-6963-10-349.
Interventions to improve blood pressure control in hypertension have had limited success in clinical practice despite evidence of cardiovascular disease prevention in randomised controlled trials.The objectives of this study were to evaluate blood pressure control and antihypertensive pharmacotherapy patterns in a population of Eastern Central Region of Portugal, attending a hospital outpatient clinic (ambulatory setting) for routine follow-up.
Medical data of all patients that attended at least two medical appointments of hypertension/dyslipidemia in a university hospital over a one and a half year period (from January 2008 to June 2009) were retrospectively analysed. Demographic variables, clinical data and blood pressure values of hypertensive patients included in the study, as well as prescribing metrics were examined on a descriptive basis and expressed as the mean ± SD, frequency and percentages. Student's test and Mann-Whitney rank sum test were used to compare continuous variables and χ2 test and Fisher exact probability test were used to test for differences between categorical variables.
In all, 37% of hypertensive patients (n = 76) had their blood pressure controlled according to international guidelines. About 45.5% of patients with a target blood pressure <140/90 mmHg (n = 156) were controlled, whereas in patients with diabetes or chronic kidney disease (n = 49) the corresponding figure was only 10.2% (P < 0.001). Among patients initiating hypertension/dyslipidemia consultation within the study period 32.1% had stage 2 hypertension in the first appointment, but this figure decreased to 3.6% in the last consultation (P = 0.012). Thiazide-type diuretics were the most prescribed antihypertensive drugs (67%) followed by angiotensin receptor blockers (60%) and beta-blockers (43%). About 95.9% patients with comorbid diabetes were treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker.
Clinically important blood pressure decreases can be achieved soon after hypertension medical appointment initiation. However, many hypertensive patients prescribed with antihypertensive therapy fail to achieve blood pressure control in clinical practice, this control being worse among patients with diabetes or chronic kidney disease. As pharmacotherapy patterns seem to coincide with international guidelines, further research is needed to identify the causes of poor blood pressure control.
尽管随机对照试验证明了心血管疾病预防的效果，但改善高血压患者血压控制的干预措施在临床实践中收效甚微。本研究的目的是评估葡萄牙中东部地区一个人群的血压控制情况和降压药物治疗模式，这些患者在大学医院的门诊（门诊环境）进行常规随访。
回顾性分析了 2008 年 1 月至 2009 年 6 月期间在一家大学医院至少两次就诊高血压/血脂异常的所有患者的医疗数据。研究包括高血压患者的人口统计学变量、临床数据和血压值以及开处方指标，均以描述性方式进行检查，并表示为平均值±标准差、频率和百分比。使用 Student's 检验和 Mann-Whitney 秩和检验比较连续变量，使用χ2检验和 Fisher 确切概率检验比较分类变量。
所有患者中，37%（n=76）的高血压患者根据国际指南控制了血压。约 45.5%（n=156）的目标血压<140/90mmHg 的患者得到了控制，而患有糖尿病或慢性肾脏病的患者（n=49）这一比例仅为 10.2%（P<0.001）。在研究期间开始高血压/血脂异常咨询的患者中，32.1%在第一次就诊时患有 2 期高血压，但在最后一次就诊时这一比例下降至 3.6%（P=0.012）。噻嗪类利尿剂是最常开的降压药（67%），其次是血管紧张素受体阻滞剂（60%）和β受体阻滞剂（43%）。约 95.9%合并糖尿病的患者使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂进行治疗。
在开始高血压就诊后不久，可实现临床意义重大的血压下降。然而，许多接受降压治疗的高血压患者在临床实践中未能控制血压，在患有糖尿病或慢性肾脏病的患者中这种控制效果更差。由于药物治疗模式似乎与国际指南一致，因此需要进一步研究以确定血压控制不佳的原因。
