Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
PLoS One. 2013 May 15;8(5):e63135. doi: 10.1371/journal.pone.0063135. Print 2013.
Blood pressure (BP) remains poorly controlled among hypertensive patients with coronary heart disease (CHD) in China. Improvement of its management will require an understanding of the patient characteristics and treatment factors associated with uncontrolled hypertension. A cross-sectional survey of 3,279 patients from 52 centers in China was performed to examine potential barriers to adequate blood pressure control of hypertensive patients with CHD. Uncontrolled hypertension was defined as blood pressure ≥130/or 80 mmHg. Multivariable logistic regression was used to identify factors associated with poor blood pressure control. Mean age of the patients was 65 years, 40% were women, and mean BMI was 25 kg/m(2). Mean systolic blood pressure was 136±18 mmHg and mean diastolic blood pressure was 80±11 mmHg. Only 18% of patients had a mean blood pressure <130/80 mmHg during the study period. Multivariate analysis revealed several independent factors of poor blood pressure control: body mass index ≥23 kg/m(2), the presence of stable angina pectoris (SAP), family history of diabetes, and use of calcium channel blockers (CCB). Further analysis showed that non-dihydropyridine calcium antagonist was significantly correlated with low BP control rate. Some of these may be amenable to modification. The results of our study suggest that overweight, the presence of SAP and family history of diabetes are important factors for tight BP control in primary care. In addition, non-dihydropyridine calcium channel blockers appear less effective than other therapies in control of blood pressure and should not be the first choice among hypertensive patients with CHD. Further identification of patients at risk of poor BP control can lead to targeted interventions to improve management.
在中国，患有冠心病的高血压患者的血压控制仍然很差。改善血压管理需要了解与未控制高血压相关的患者特征和治疗因素。对来自中国 52 个中心的 3279 名患者进行了横断面调查，以检查高血压合并冠心病患者血压控制不理想的潜在障碍。未控制的高血压定义为血压≥130/或 80mmHg。多变量逻辑回归用于确定与血压控制不佳相关的因素。患者的平均年龄为 65 岁，40%为女性，平均 BMI 为 25kg/m2。平均收缩压为 136±18mmHg，平均舒张压为 80±11mmHg。在研究期间，只有 18%的患者平均血压<130/80mmHg。多变量分析显示血压控制不佳的几个独立因素：BMI≥23kg/m2、稳定型心绞痛（SAP）的存在、糖尿病家族史和钙通道阻滞剂（CCB）的使用。进一步分析表明，非二氢吡啶类钙拮抗剂与低血压控制率显著相关。其中一些可能可以改变。我们的研究结果表明，超重、SAP 的存在和糖尿病家族史是基层医疗中严格血压控制的重要因素。此外，非二氢吡啶类钙通道阻滞剂在控制血压方面似乎不如其他治疗方法有效，不应作为高血压合并冠心病患者的首选药物。进一步确定血压控制不佳的患者，可以采取有针对性的干预措施来改善管理。
