Ledur P S, Leiria L F, Severo M D, Silveira D T, Massierer D, Becker A D, Aguiar F M, Gus M, Schaan B D
Endocrine Division, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
J Am Soc Hypertens. 2013 Nov-Dec;7(6):477-83. doi: 10.1016/j.jash.2013.07.006. Epub 2013 Aug 19.
We assessed the association between adherence to antihypertensive drug treatment and patient's perception of uncontrolled blood pressure (BP) in diabetic hypertensive subjects. This was a cross-sectional study that evaluated adherence to antihypertensives (Morisky questionnaire), patients' perception of abnormal BP, office BP, and ambulatory BP monitoring in diabetic hypertensive subjects. We evaluated 323 patients, 65.2% women, aged 56.5 ± 7 years, glycosylated hemoglobin (HbA1c) 8.0% (range, 6.9%-9.6%), diabetes duration of 10 years (range, 5-17 years). Adherence to drug treatment was 51.4%. Patients who reported hypertension-related symptoms (60.4%) had a lower level of adherence (P < .001). Non-adherence occurred four times more frequently in patients who reported hypertension-related symptoms (P < .001, adjusted for use of three or more anti-hypertensives, age, and duration of diabetes). Non-adherents had higher office diastolic BP (83.6 ± 11.9 vs. 79.8 ± 9.9; P = .003), but no difference between groups was observed considering systolic, diastolic, and mean BP evaluated by ambulatory BP monitoring. Low rates of adherence to antihypertensive drug treatment were observed in outpatient hypertensive diabetic subjects. Perception of uncontrolled BP levels was strongly and independently associated with non-adherence. Non-adherence determined repercussion on office BP that may have clinical implications in cardiovascular risk.
我们评估了糖尿病高血压患者中抗高血压药物治疗依从性与患者对血压未得到控制的认知之间的关联。这是一项横断面研究，评估了糖尿病高血压患者对抗高血压药物的依从性（使用Morisky问卷）、患者对异常血压的认知、诊室血压及动态血压监测情况。我们评估了323例患者，其中女性占65.2%，年龄为56.5±7岁，糖化血红蛋白（HbA1c）为8.0%（范围6.9%-9.6%），糖尿病病程为10年（范围5-17年）。药物治疗依从率为51.4%。报告有高血压相关症状的患者（60.4%）依从性较低（P<0.001）。报告有高血压相关症状的患者不依从情况的发生频率是其他患者的4倍（经使用三种或更多抗高血压药物、年龄及糖尿病病程校正后，P<0.001）。不依从患者的诊室舒张压较高（83.6±11.9对79.8±9.9；P=0.003），但在动态血压监测评估的收缩压、舒张压及平均血压方面，两组之间未观察到差异。门诊高血压糖尿病患者中抗高血压药物治疗的依从率较低。对血压未得到控制的认知与不依从密切且独立相关。不依从对诊室血压有影响，这可能对心血管风险具有临床意义。
