Division of Cardiology, University of Colorado School of Medicine, 12605 E 16th Ave, Mail Stop B130, PO Box 6511, Aurora, CO 80045, USA.
Hypertension. 2012 Aug;60(2):303-9. doi: 10.1161/HYPERTENSIONAHA.112.192096. Epub 2012 Jun 25.
Patients with resistant hypertension are at risk for poor outcomes. Medication adherence and intensification improve blood pressure (BP) control; however, little is known about these processes or their association with outcomes in resistant hypertension. This retrospective study included patients from 2002 to 2006 with incident hypertension from 2 health systems who developed resistant hypertension or uncontrolled BP despite adherence to ≥3 antihypertensive medications. Patterns of hypertension treatment, medication adherence (percentage of days covered), and treatment intensification (increase in medication class or dose) were described in the year after resistant hypertension identification. Then, the association between medication adherence and intensification with 1-year BP control was assessed controlling for patient characteristics. Of the 3550 patients with resistant hypertension, 49% were male, and mean age was 60 years. One year after resistance hypertension determination, fewer patients were taking diuretics (77.7% versus 92.2%; P<0.01), β-blockers (71.2% versus 79.4%; P<0.01), and angiotensinogen-converting enzyme inhibitor/angiotensin receptor blocker (64.8% versus 70.1%; P<0.01) compared with baseline. Rates of BP control improved over 1 year (22% versus 55%; P<0.01). During this year, adherence was not associated with 1-year BP control (adjusted odds ratio, 1.18 [95% CI: 0.94-1.47]). Treatment was intensified in 21.6% of visits with elevated BP. Increasing treatment intensity was associated with 1-year BP control (adjusted odds ratio, 1.64 [95% CI, 1.58-1.71]). In this cohort of patients with resistant hypertension, treatment intensification but not medication adherence was significantly associated with 1-year BP control. These findings highlight the need to investigate why patients with uncontrolled BP do not receive treatment intensification.
患有耐药性高血压的患者预后不良风险较高。药物依从性和强化治疗可改善血压（BP）控制；然而，对于这些过程及其与耐药性高血压患者结局的关联，我们知之甚少。本回顾性研究纳入了来自 2002 年至 2006 年的患者，这些患者来自 2 个医疗系统，他们在使用≥3 种降压药物的情况下发生了高血压，且发展为耐药性高血压或血压仍未得到控制。在确定耐药性高血压后 1 年内，描述了高血压治疗模式、药物依从性（覆盖率百分比）和治疗强化（增加药物种类或剂量）。然后，评估了药物依从性和强化治疗与 1 年 BP 控制之间的关联，控制了患者特征。在 3550 名耐药性高血压患者中，49%为男性，平均年龄为 60 岁。在确定耐药性高血压后 1 年内，与基线相比，服用利尿剂（77.7% vs 92.2%；P<0.01）、β受体阻滞剂（71.2% vs 79.4%；P<0.01）和血管紧张素原转换酶抑制剂/血管紧张素受体阻滞剂（64.8% vs 70.1%；P<0.01）的患者较少。在 1 年内，BP 控制得到改善（22% vs 55%；P<0.01）。在此期间，药物依从性与 1 年 BP 控制无关（调整后比值比，1.18 [95%CI：0.94-1.47]）。在血压升高的就诊中，有 21.6%进行了治疗强化。增加治疗强度与 1 年 BP 控制相关（调整后比值比，1.64 [95%CI，1.58-1.71]）。在本耐药性高血压患者队列中，治疗强化而不是药物依从性与 1 年 BP 控制显著相关。这些发现强调了需要研究为什么血压未得到控制的患者未接受治疗强化。
