Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Center for Disease Control and Prevention, Room 4333, 3311 Toledo Rd, Hyattsville, MD 20782, USA.
Circulation. 2012 Oct 23;126(17):2105-14. doi: 10.1161/CIRCULATIONAHA.112.096156.
The monitoring of national trends in hypertension treatment and control can provide important insight into the effectiveness of primary prevention efforts for cardiovascular disease. The objective of this study was to examine recent trends in antihypertensive medication use and its impact on blood pressure control among US adults with hypertension.
A total of 9320 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey 2001 to 2010 were included in this study. The prevalence of antihypertensive medication use increased from 63.5% in 2001 to 2002 to 77.3% in 2009 to 2010 (P(trend)<0.01). Most notably, there was a large increase in the use of multiple antihypertensive agents (from 36.8% to 47.7%, P(trend)<0.01). Overall, the use of thiazide diuretics, β-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers increased by 23%, 57%, 31%, and 100%, respectively. In comparison with monotherapy, single-pill combinations and multiple-pill combinations were associated with 55% and 26% increased likelihoods of blood pressure control, respectively. By the 2009 to 2010 time period, 47% of all hypertensive people and 60% of treated hypertensive people had blood pressure controlled. However, higher treated but uncontrolled hypertension rates continued to persist among older Americans, non-Hispanic blacks, diabetic people, and those with chronic kidney disease. Also, Mexican Americans with hypertension were still less likely to take antihypertensive medication than non-Hispanic whites with hypertension.
Antihypertensive medication use and blood pressure control among US adults with hypertension significantly increased over the past 10 years. Combination therapy regimens can facilitate achievement of blood pressure goals.
监测高血压治疗和控制的国家趋势可以为评估心血管疾病一级预防措施的效果提供重要信息。本研究旨在评估美国高血压患者中降压药物的使用趋势及其对血压控制的影响。
本研究共纳入了 9320 名年龄≥18 岁的高血压患者，这些患者来自 2001 至 2010 年的国家健康和营养调查。降压药物的使用率从 2001 至 2002 年的 63.5%上升至 2009 至 2010 年的 77.3%（趋势 P<0.01）。值得注意的是，联合使用多种降压药物的比例有大幅增加（从 36.8%增至 47.7%，趋势 P<0.01）。总的来说，噻嗪类利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的使用率分别增加了 23%、57%、31%和 100%。与单药治疗相比，单片复方制剂和多片复方制剂使血压控制的可能性分别增加了 55%和 26%。到 2009 至 2010 年期间，47%的高血压患者和 60%的高血压治疗患者血压得到了控制。然而，在年龄较大的美国人、非西班牙裔黑人、糖尿病患者和慢性肾脏病患者中，治疗但血压未控制的高血压比例仍然较高。此外，患有高血压的墨西哥裔美国人服用降压药物的可能性仍低于患有高血压的非西班牙裔白人。
过去 10 年来，美国高血压患者中降压药物的使用率和血压控制情况显著提高。联合治疗方案可以更有效地达到血压目标。
