Ochsner Clinic Foundation and Tulane University, New Orleans, LA 70121, USA.
J Clin Hypertens (Greenwich). 2012 May;14(5):277-83. doi: 10.1111/j.1751-7176.2012.00609.x. Epub 2012 Mar 16.
Medication prescribing practice changed following the publications of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) in 2002 and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) in 2003. Few data are available on changes in hypertension control rates for patients initiating antihypertensive treatment before and after these publications. The authors compared systolic and diastolic blood pressure (SBP and DBP) levels and hypertension control (SBP <140 mm Hg and DBP <90 mm Hg) rates in patients initiating antihypertensive treatment in a large managed care organization during 2 time periods: July 1, 2001, to June 30, 2002 (n=322); and July 1, 2003, to June 30, 2004 (n=323). The blood pressure reduction associated with antihypertensive medication initiation was similar in 2001-2002 and 2003-2004 (-11.9 and -10.5 mm Hg, respectively, P=.251 for SBP; -6.9 and -5.9 mm Hg, respectively, P=.160 for DBP). The mean SBP and DBP prior to treatment were significantly lower in 2003-2004 vs 2001-2002 (145.4 vs 151.3 mm Hg, P<.001 for SBP; 87.6 vs 90.1 mm Hg, P<.002 for DBP). Hypertension control rates increased from 38.0% to 50.2% (P=.005) from 2001-2002 to 2003-2004. Lower pretreatment SBP and DBP explained hypertension control improvement over time. In this real-world clinic population, antihypertensive treatment was initiated at lower blood pressure levels following publication of ALLHAT and JNC 7, resulting in substantial improvements in hypertension control rates.
自 2002 年发表《抗高血压和降脂治疗预防心脏病试验》（ALLHAT）和 2003 年发表《第七次联合国家委员会预防、检测、评估和治疗高血压报告》（JNC 7）以来，药物处方实践发生了变化。关于这些出版物前后开始抗高血压治疗的患者高血压控制率变化的数据很少。作者比较了在大型管理式医疗组织中，在两个时间段开始抗高血压治疗的患者的收缩压和舒张压（SBP 和 DBP）水平和高血压控制（SBP <140mmHg 和 DBP <90mmHg）率：2001 年 7 月 1 日至 2002 年 6 月 30 日（n=322）；2003 年 7 月 1 日至 2004 年 6 月 30 日（n=323）。抗高血压药物治疗开始时血压降低在 2001-2002 年和 2003-2004 年相似（分别为 SBP 降低 11.9 和 10.5mmHg，P=0.251；DBP 分别降低 6.9 和 5.9mmHg，P=0.160）。2003-2004 年治疗前的平均 SBP 和 DBP 明显低于 2001-2002 年（SBP 分别为 145.4 和 151.3mmHg，P<.001；DBP 分别为 87.6 和 90.1mmHg，P<.002）。2001-2002 年至 2003-2004 年，高血压控制率从 38.0%增加到 50.2%（P=.005）。随着时间的推移，较低的预处理 SBP 和 DBP 解释了高血压控制的改善。在这个真实世界的临床人群中，在 ALLHAT 和 JNC 7 发表后，抗高血压治疗开始于较低的血压水平，导致高血压控制率的显著提高。
