Ferrario Carlos M, Joyner Janae, Colby Chris, Exuzides Alex, Moore Michael, Simmons Debra, Bestermann William, Frech-Tamas Feride
Department of Surgery, Internal Medicine-Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Vasc Health Risk Manag. 2013;9:391-400. doi: 10.2147/VHRM.S44950. Epub 2013 Jul 22.
The Global Vascular Risk Management (GVRM) Study is a 5-year prospective observational study of 87,863 patients (61% females) with hypertension and associated cardiovascular risk factors began January 1, 2010. Data are gathered electronically and cardiovascular risk is evaluated using the Consortium for Southeastern Hypertension Control™ (COSEHC™)-11 risk score. Here, we report the results obtained at the completion of 33 months since study initiation. De-identified electronic medical records of enrolled patients were used to compare clinical indicators, antihypertensive medication usage, and COSEHC™ risk scores across sex and diabetic status subgroups. The results from each subgroup, assessed at baseline and at regular follow-up periods, are reported since the project initiation. Inference testing was performed to look for statistically significant differences between goal attainments rates between sexes. At-goal rates for systolic blood pressure (SBP) were improved during the 33 months of the study, with females achieving higher goal rates when compared to males. On the other hand, at-goal control rates for total and low-density lipoprotein (LDL) cholesterol (chol) were better in males compared to females. Diabetic patients had lower at-goal rates for SBP and triglycerides but higher rates for LDL-chol. The LDL-chol at-goal rates were higher for males, while high-density lipoprotein (HDL)-chol rates were higher for females. Utilization of antihypertensive medications was similar during and after the baseline period for both men and women. Patients taking two or more antihypertensive medications had higher mean COSEHC™-11 scores compared to those on monotherapy. With treatment, hypertensive patients can reach SBP and cholesterol goals; however, population-wide improvement in treatment goal adherence continues to be a challenge for physicians. The COSEHC™ GVRM Study shows, however, that continuous monitoring and feedback to physicians of accurate longitudinal data is an effective tool in achieving better control rates of cardiovascular risk factors.
全球血管风险管理（GVRM）研究是一项针对87863名高血压及相关心血管危险因素患者（61%为女性）的为期5年的前瞻性观察性研究，于2010年1月1日开始。数据通过电子方式收集，并使用东南高血压控制联盟（COSEHC™）-11风险评分评估心血管风险。在此，我们报告自研究开始33个月结束时获得的结果。使用已去识别化的登记患者电子病历，比较性别和糖尿病状态亚组之间的临床指标、抗高血压药物使用情况以及COSEHC™风险评分。自项目启动以来，报告了在基线和定期随访期间评估的每个亚组的结果。进行了推断测试，以寻找性别之间目标达成率的统计学显著差异。在研究的33个月期间，收缩压（SBP）的达标率有所提高，女性的达标率高于男性。另一方面，男性的总胆固醇和低密度脂蛋白（LDL）胆固醇（chol）的达标控制率优于女性。糖尿病患者的SBP和甘油三酯达标率较低，但LDL-chol达标率较高。男性的LDL-chol达标率较高，而女性的高密度脂蛋白（HDL）-chol达标率较高。男性和女性在基线期及之后抗高血压药物的使用情况相似。服用两种或更多种抗高血压药物的患者的平均COSEHC™-11评分高于单药治疗患者。通过治疗，高血压患者可以达到SBP和胆固醇目标；然而，在全人群中提高治疗目标依从性对医生来说仍然是一个挑战。然而，COSEHC™ GVRM研究表明，持续向医生监测和反馈准确的纵向数据是实现更好地控制心血管危险因素的有效工具。
