Center for Health Outcomes and PharmacoEconomic Research, and Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 N. Martin, Tucson, AZ 85721, USA.
Nutr Metab Cardiovasc Dis. 2013 Apr;23(4):314-22. doi: 10.1016/j.numecd.2011.06.005. Epub 2011 Sep 17.
Obesity combined with hypertension places patients at greater risk for target-organ damage and cardiovascular disease. The purpose of this secondary analysis was to identify physician- and patient-levels determinants of blood pressure (BP) values and predictors of uncontrolled BP through subgroup analysis by body mass index (BMI).
We conducted a subgroup analysis of 3006 patients with High-BMI (BMI >25 kg/m(2); n=2124) and Normal-BMI (BMI<25 kg/m(2); n=882) treated by 504 physicians and enrolled in PREVIEW, a Belgian prospective, multi-center, pharmaco-epidemiological study of 90-day second-line treatment with valsartan. Physician- and patient-level determinants of BP values and BP control were identified by means of hierarchical linear and logistic regression. Blood pressure values and control after 90 days of treatment were consistently lower for the High-BMI group. The 25.5% of variance in 90-day systolic and 28.3% of the variance in 90-day diastolic BP were attributable to physician-level determinants for the High-BMI group; versus 27.3% and 29.8% for the Normal-BMI group (ICC=0.273 and 0.298, respectively). Determinants of 90-day BP values and predictors of uncontrolled BP varied considerably by BMI status.
Several common and unique patient- and physician-level determinants of BP values and control were identified for the High-BMI and Normal-BMI groups. These findings highlight the need for differentiating healthcare interventions to account for patient and physician variables, particularly with respect to effective BP management in vulnerable populations.
肥胖合并高血压使患者发生靶器官损害和心血管疾病的风险增加。本二次分析的目的是通过亚组分析体重指数（BMI）来确定血压（BP）值的医生和患者水平决定因素以及未控制BP的预测因素。
我们对 504 名医生治疗的 3006 名高 BMI（BMI>25kg/m2；n=2124）和正常 BMI（BMI<25kg/m2；n=882）患者进行了亚组分析，这些患者参加了比利时前瞻性、多中心、药物流行病学研究 PREVIEW，该研究评估了缬沙坦 90 天二线治疗的疗效。通过分层线性和逻辑回归确定了 BP 值和 BP 控制的医生和患者水平决定因素。治疗 90 天后，高 BMI 组的 BP 值和控制均较低。90 天收缩压的 25.5%和 90 天舒张压的 28.3%的方差归因于高 BMI 组的医生水平决定因素；而正常 BMI 组分别为 27.3%和 29.8%（ICC=0.273 和 0.298）。90 天 BP 值的决定因素和未控制 BP 的预测因素因 BMI 状况而异。
确定了高 BMI 和正常 BMI 组的血压值和控制的一些常见和独特的患者和医生水平决定因素。这些发现强调需要区分医疗保健干预措施，以考虑患者和医生的变量，特别是在脆弱人群中有效管理血压方面。
