Saseen Joseph J, Ghushchyan Vahram, Kaila Shuchita, Allen Richard R, Nair Kavita V
Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO; Department of Family Medicine , School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
J Clin Hypertens (Greenwich). 2013 Dec;15(12):888-92. doi: 10.1111/jch.12197. Epub 2013 Sep 19.
This study assessed blood pressure (BP) goal maintenance in patients controlled with olmesartan monotherapy after switching to another angiotensin type II receptor blocker (ARB). Hypertensive patients prescribed olmesartan monotherapy were identified from GE Healthcare's Centricity electronic medical record between 2007 and 2011. After documentation of BP goal (<140/90 mm Hg) attainment, patients were placed into the continuation cohort if olmesartan monotherapy was maintained or into the switch cohort if they were changed to irbesartan, losartan, or valsartan. Follow-up assessments were the first BP measurement 28 to 390 days after attaining BP goal (continuation cohort) or after prescribing an alternative ARB (switch cohort). Of 3412 patients included (3027 continuation cohort, 385 switch cohort), 52% were women and mean age was 58.0 years. In the switch cohort, 310 (80.5%) were switched to losartan (n=236), irbesartan (n=58), or valsartan (n=16) monotherapy and 75 (19.5%) were switched to combination antihypertensive therapy. Mean baseline and follow-up BP were 122.5/75.8 mm Hg and 126.6/77.6 mm Hg, respectively, in the continuation cohort (P<.001) and 123.5/75.4 mm Hg and 129.6/78.5 mm Hg, respectively, in the switch cohort (P<.001). BP goal maintenance was 78.7% and 72.2% in the continuation and switch cohort, respectively (odds ratio, 0.707; 95% confidence interval, 0.555-0.899). Patients who continued on olmesartan monotherapy after attaining BP goal had a higher percentage of BP goal maintenance than patients who switched therapy.
本研究评估了接受奥美沙坦单药治疗且血压得到控制的患者换用另一种血管紧张素II受体阻滞剂（ARB）后血压目标的维持情况。2007年至2011年期间，从通用电气医疗集团的Centricity电子病历中识别出接受奥美沙坦单药治疗的高血压患者。在记录到血压目标（<140/90 mmHg）达成后，如果继续使用奥美沙坦单药治疗，患者被纳入继续治疗队列；如果换用厄贝沙坦、氯沙坦或缬沙坦，则被纳入换药队列。随访评估是在达到血压目标后28至390天（继续治疗队列）或开具替代ARB药物后（换药队列）进行的首次血压测量。纳入的3412例患者中（继续治疗队列3027例，换药队列385例），52%为女性，平均年龄为58.0岁。在换药队列中，310例（80.5%）换用氯沙坦（n = 236）、厄贝沙坦（n = 58）或缬沙坦（n = 16）单药治疗，75例（19.5%）换用联合降压治疗。继续治疗队列的平均基线血压和随访血压分别为122.5/75.8 mmHg和126.6/77.6 mmHg（P <.001），换药队列分别为123.5/75.4 mmHg和129.6/78.5 mmHg（P <.001）。继续治疗队列和换药队列的血压目标维持率分别为78.7%和72.2%（优势比，0.707；95%置信区间，0.555 - 0.899）。达到血压目标后继续使用奥美沙坦单药治疗的患者血压目标维持率高于换药治疗的患者。
