Robarts Clinical Trials, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
J Clin Hypertens (Greenwich). 2011 Feb;13(2):73-80. doi: 10.1111/j.1751-7176.2010.00392.x. Epub 2010 Dec 10.
Despite improvements in blood pressure (BP) control, a substantial percentage of patients do not achieve target. The relative importance of determinants of poor BP control is unclear. Therefore, the authors conducted a post hoc exploratory analysis to assess determinants of BP control. Data were collected in 45 general practices, which enrolled patients with uncontrolled hypertension. Antihypertensive medication changes throughout the 6-month follow-up period were documented. Baseline and 6-month BPs were recorded. Of the 2030 patients analyzed, 320 had diabetes. Overall, 42% of patients did not achieve BP control. In multivariate analysis, failure to intensify therapy was identified as a significant independent predictor of lesser BP reduction. Of patients unable to reach target after 6 months, only 25% were prescribed ≥ 3 drugs. Patients with diabetes were significantly less likely to reach target than those without (26% vs 64%, P<.001). Antihypertensive therapy prescribed to patients with diabetes was only marginally more intensive than to those without. In patients with hypertension, whether with or without coexisting diabetes, poor BP control appears to be at least partially due to failure to uptitrate antihypertensive therapy. Clinical inertia is likely an important barrier to BP control.
尽管血压（BP）控制有所改善，但仍有相当一部分患者未达到目标。血压控制不佳的决定因素的相对重要性尚不清楚。因此，作者进行了一项事后探索性分析，以评估血压控制的决定因素。数据收集于 45 家普通诊所，这些诊所招募了血压未得到控制的高血压患者。在 6 个月的随访期间，记录了抗高血压药物的变化。记录了基线和 6 个月时的血压。在分析的 2030 名患者中，有 320 名患有糖尿病。总体而言，42%的患者未达到血压控制目标。在多变量分析中，未能加强治疗被确定为血压降低幅度较小的显著独立预测因素。在 6 个月后仍未达到目标的患者中，只有 25%开了≥3 种药物。患有糖尿病的患者达到目标的可能性明显低于没有糖尿病的患者（26%比 64%，P<.001）。与没有糖尿病的患者相比，为患有糖尿病的患者开的降压药仅略为强化。在患有高血压的患者中，无论是否伴有并存的糖尿病，血压控制不佳似乎至少部分是由于未能提高抗高血压治疗的剂量。临床惰性可能是血压控制的一个重要障碍。
