Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, 1230 RT, Charleston, SC 29425, USA.
Circulation. 2011 Aug 30;124(9):1046-58. doi: 10.1161/CIRCULATIONAHA.111.030189. Epub 2011 Aug 8.
Despite progress, many hypertensive patients remain uncontrolled. Defining characteristics of uncontrolled hypertensives may facilitate efforts to improve blood pressure control.
Subjects included 13,375 hypertensive adults from National Health and Nutrition Examination Surveys (NHANESs) subdivided into 1988 to 1994, 1999 to 2004, and 2005 to 2008. Uncontrolled hypertension was defined as blood pressure ≥140/≥90 mm Hg and apparent treatment-resistant hypertension (aTRH) when subjects reported taking ≥3 antihypertensive medications. Framingham 10-year coronary risk was calculated. Multivariable logistic regression was used to identify clinical characteristics associated with untreated, treated uncontrolled on 1 to 2 blood pressure medications, and aTRH across all 3 survey periods. More than half of uncontrolled hypertensives were untreated across surveys, including 52.2% in 2005 to 2008. Clinical factors linked with untreated hypertension included male sex, infrequent healthcare visits (0 to 1 per year), body mass index <25 kg/m2, absence of chronic kidney disease, and Framingham 10-year coronary risk <10% (P<0.01). Most treated uncontrolled patients reported taking 1 to 2 blood pressure medications, a proxy for therapeutic inertia. This group was older, had higher Framingham 10-year coronary risk than patients controlled on 1 to 2 medications (P<0.01), and comprised 34.4% of all uncontrolled and 72.0% of treated uncontrolled patients in 2005 to 2008. We found that aTRH increased from 15.9% (1998-2004) to 28.0% (2005-2008) of treated patients (P<0.001). Clinical characteristics associated with aTRH included ≥4 visits per year, obesity, chronic kidney disease, and Framingham 10-year coronary risk >20% (P<0.01).
Untreated, undertreated, and aTRH patients have consistent characteristics that could inform strategies to improve blood pressure control by decreasing untreated hypertension, reducing therapeutic inertia in undertreated patients, and enhancing therapeutic efficiency in aTRH.
尽管取得了进展，但许多高血压患者的血压仍未得到控制。确定未控制高血压患者的特征可能有助于改善血压控制。
研究对象包括来自国家健康和营养检查调查（NHANES）的 13375 名成年高血压患者，分为 1988 年至 1994 年、1999 年至 2004 年和 2005 年至 2008 年。未控制的高血压定义为血压≥140/≥90mmHg，当患者报告服用≥3 种降压药物时，出现明显的治疗抵抗性高血压（aTRH）。计算了弗雷明汉 10 年冠心病风险。多变量逻辑回归用于确定与所有 3 个调查期间未经治疗、用 1 至 2 种降压药物治疗但血压仍未控制以及 aTRH 相关的临床特征。超过一半的未控制高血压患者在所有调查中未经治疗，包括 2005 年至 2008 年的 52.2%。与未经治疗的高血压相关的临床因素包括男性、医疗保健就诊次数少（每年 0 至 1 次）、体重指数<25kg/m2、无慢性肾脏病和弗雷明汉 10 年冠心病风险<10%（P<0.01）。大多数接受治疗的未控制患者报告服用 1 至 2 种降压药物，这是治疗惰性的一个指标。该组年龄较大，与用 1 至 2 种药物控制血压的患者相比，弗雷明汉 10 年冠心病风险更高（P<0.01），在 2005 年至 2008 年期间，该组占所有未控制和 72.0%的治疗未控制患者。我们发现，治疗患者中 aTRH 的比例从 1998-2004 年的 15.9%增加到 2005-2008 年的 28.0%（P<0.001）。与 aTRH 相关的临床特征包括每年就诊≥4 次、肥胖、慢性肾脏病和弗雷明汉 10 年冠心病风险>20%（P<0.01）。
未经治疗、治疗不足和 aTRH 的患者具有一致的特征，这些特征可能有助于通过减少未经治疗的高血压、减少治疗不足患者的治疗惰性以及提高 aTRH 的治疗效率来改善血压控制。
