基层医疗环境中难治性高血压的患病率及预测因素：一项横断面研究
Prevalence and predictors of resistant hypertension in a primary care setting: a cross-sectional study.
作者信息
Chia Yook Chin, Ching Siew Mooi
机构信息
Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
出版信息
BMC Fam Pract. 2014 Jul 5;15:131. doi: 10.1186/1471-2296-15-131.
BACKGROUND
Patients with resistant hypertension are subjected to a higher risk of getting stroke, myocardial infarction, congestive heart failure and renal failure. However, the exact prevalence of resistant hypertension in treated hypertensive patients in Malaysia is not known. This paper examines the prevalence and determinants of resistant hypertension in a sample of hypertensive patients.
METHODS
We examined the control of blood pressure in a randomly selected sample of patients with hypertension in a primary care clinic. Demographic data, blood pressure and anti-hypertensive drug use were captured from patient records at the end of 2007. Resistant hypertension is defined as failure to achieve target blood pressure of < 140/90 mmHg while on full doses of an appropriate three-drug regimen that includes a diuretic. Multivariate logistic regression was used for the analysis.
RESULTS
A total of 1217 patients with hypertension were entered into the analysis. Mean age of the patients was 66.8 ± 9.7 years and 64.4% were female. More than half of the subjects (56.9%) had diabetes mellitus. Median BP was 130/80 mmHg. Overall prevalence of resistant hypertension was 8.8% (N = 107/1217). In multivariate logistic regression analysis, presence of chronic kidney disease is more likely to be associated with resistant hypertension (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.56-5.35). On the other hand, increase per year of age is associated with lower odds of resistant hypertension in this population (OR 0.96, 95% CI 0.93-0.99).
CONCLUSIONS
Resistant hypertension is present in nearly one in ten hypertensive patients on treatment. Hypertensive patients who have underlying chronic kidney disease are associated with higher odds of having resistant hypertension. Hence, in managing patients with hypertension, primary care physicians should be more alert and identify patients with chronic kidney disease as such patients are more likely to develop resistant hypertension. By doing that, these patients can be treated more aggressively earlier in order to achieve blood pressure target and thus reduce cardiovascular events.
背景
顽固性高血压患者发生中风、心肌梗死、充血性心力衰竭和肾衰竭的风险更高。然而，马来西亚接受治疗的高血压患者中顽固性高血压的确切患病率尚不清楚。本文研究了高血压患者样本中顽固性高血压的患病率及其决定因素。
方法
我们在一家基层医疗诊所对随机抽取的高血压患者样本的血压控制情况进行了检查。在2007年底从患者记录中获取人口统计学数据、血压和抗高血压药物使用情况。顽固性高血压定义为在使用包括利尿剂在内的适当三联药物全剂量治疗时，未能达到<140/90 mmHg的目标血压。采用多因素逻辑回归进行分析。
结果
共有1217例高血压患者纳入分析。患者的平均年龄为66.8±9.7岁，女性占64.4%。超过一半的受试者（56.9%）患有糖尿病。血压中位数为130/80 mmHg。顽固性高血压的总体患病率为8.8%（N = 107/1217）。在多因素逻辑回归分析中，慢性肾病的存在更有可能与顽固性高血压相关（比值比[OR] 2.89，95%置信区间[CI] 1.56 - 5.35）。另一方面，在该人群中，年龄每增加一岁，患顽固性高血压的几率就越低（OR 0.96，95% CI 0.93 - 0.99）。
结论
接受治疗的高血压患者中，近十分之一患有顽固性高血压。患有潜在慢性肾病的高血压患者患顽固性高血压的几率更高。因此，在管理高血压患者时，基层医疗医生应更加警惕，识别出患有慢性肾病的患者，因为这类患者更有可能发展为顽固性高血压。通过这样做，可以更早地对这些患者进行更积极的治疗，以实现血压目标，从而减少心血管事件。
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