高血压合并高胆固醇血症患者的血压和胆固醇控制：1988-2010 年全国健康和营养调查。
Blood pressure and cholesterol control in hypertensive hypercholesterolemic patients: national health and nutrition examination surveys 1988-2010.
机构信息
Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, RT 1230, Charleston, SC 29425, USA.
出版信息
Circulation. 2013 Jul 2;128(1):29-41. doi: 10.1161/CIRCULATIONAHA.112.000500.
BACKGROUND
Hypertension doubles coronary heart disease (CHD) risk. Treating hypertension only reduces CHD risk ≈25%. Treating hypercholesterolemia in hypertensive patients reduces residual CHD risk >35%.
METHODS AND RESULTS
To assess progress in concurrent hypertension and hypercholesterolemia control, National Health and Nutrition Examination Surveys 1988 to 1994, 1999 to 2004, and 2005 to 2010 were analyzed. Hypertension was defined by blood pressure ≥140/≥90 mm Hg, current medication treatment, and 2-told hypertension status; blood pressure <140/<90 defined control. Hypercholesterolemia was defined by ATP III criteria based on 10-year CHD risk, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol; values below diagnostic thresholds defined control. Across surveys, 60.7% to 64.3% of hypertensives were hypercholesterolemic. From 1988 to 1994 to 2005 to 2010, control of LDL-C rose (9.2% [95% confidence interval (CI), 6.6%-11.9%] to 45.4% [95% CI, 42.6%-48.3%]), concomitant hypertension and LDL-C (5.0% [95% CI, 3.3%-6.7%] to 30.7% [95% CI, 27.9%-33.4%]), and combined hypertension, LDL-C, and non-high-density lipoprotein cholesterol (1.8% [95% CI, 0.4%-3.2%] to 26.9% [95% CI, 24.4%-29.5%]). By multivariable logistic regression, factors associated with concomitant hypertension, LDL-C, and non-high-density lipoprotein cholesterol control (odds ratio [95% CI]) were statin (10.7 [8.1-14.3]) and antihypertensive (3.32 [2.45-4.50]) medications, age (0.77 [0.69-0.88]/10-year increase), ≥2 healthcare visits/yr (1.90 [1.26-2.87]), black race (0.59 [0.44-0.80]), Hispanic ethnicity (0.62 [0.43-0.90]), cardiovascular disease (0.44 [0.34-0.56]), and diabetes mellitus (0.54 [0.42-0.70]).
CONCLUSIONS
Despite progress, opportunities for improving concomitant hypertension and hypercholesterolemia control persist. Prescribing antihypertensive and antihyperlipidemic medications to achieve treatment goals, especially for older, minority, diabetic, and cardiovascular disease patients, and accessing healthcare at least biannually could improve concurrent risk factor control and CHD prevention.
背景
高血压使冠心病（CHD）风险增加一倍。仅治疗高血压可将 CHD 风险降低约 25%。治疗高血压患者的高胆固醇血症可使残余 CHD 风险降低 >35%。
方法和结果
为了评估同时控制高血压和高胆固醇血症的进展，分析了 1988 年至 1994 年、1999 年至 2004 年和 2005 年至 2010 年的国家健康和营养检查调查。高血压定义为血压≥140/≥90mmHg、当前药物治疗和两次高血压病史；血压<140/<90 定义为控制。高胆固醇血症根据基于 10 年冠心病风险、低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇的 ATP III 标准定义；低于诊断阈值的数值定义为控制。在整个调查中，60.7%至 64.3%的高血压患者患有高胆固醇血症。从 1988 年至 1994 年至 2005 年至 2010 年，LDL-C 的控制率上升（9.2%[95%置信区间（CI），6.6%-11.9%]至 45.4%[95%CI，42.6%-48.3%]），同时存在高血压和 LDL-C（5.0%[95%CI，3.3%-6.7%]至 30.7%[95%CI，27.9%-33.4%]），以及联合高血压、LDL-C 和非高密度脂蛋白胆固醇（1.8%[95%CI，0.4%-3.2%]至 26.9%[95%CI，24.4%-29.5%]）。通过多变量逻辑回归，与同时控制高血压、LDL-C 和非高密度脂蛋白胆固醇相关的因素（比值比[95%CI]）包括他汀类药物（10.7[8.1-14.3]）和降压药物（3.32[2.45-4.50]）、年龄（每增加 10 岁 0.77[0.69-0.88]）、每年≥2 次医疗保健访问（1.90[1.26-2.87]）、黑人种族（0.59[0.44-0.80]）、西班牙裔（0.62[0.43-0.90]）、心血管疾病（0.44[0.34-0.56]）和糖尿病（0.54[0.42-0.70]）。
结论
尽管取得了进展，但仍有机会改善同时控制高血压和高胆固醇血症的情况。开处方降压药和降脂药以达到治疗目标，特别是针对年龄较大、少数民族、糖尿病和心血管疾病患者，并至少每半年进行一次医疗保健，可改善同时存在的危险因素控制和 CHD 预防。
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