Zeymer Uwe, Dechend Ralf, Riemer Thomas, Kaiser Edelgard, Senges Jochen, Pittrow David, Schmieder Roland E
Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
Helios-Klinikum Berlin-Buch, Berlin, Germany.
Int J Cardiol. 2014 Oct 20;176(3):589-94. doi: 10.1016/j.ijcard.2014.07.089. Epub 2014 Aug 1.
Current data on characteristics and outcomes of patients with high blood pressure (BP) managed under clinical practice conditions are limited.
The 3A registry is an open, prospective observational cohort study in German primary care offices, with a 4:1:1 inclusion ratio to either aliskiren (ALIS), an ACE inhibitor/angiotensin receptor blocker (ACEI/ARB), or to an antihypertensive agent not affecting the renin angiotensin system (non-RAS). A nonlinear mixed regression model was used to assess BP changes during follow-up regarding different BP values at inclusion in the various groups. ClinicalTrial.gov identifier is NCT01454583. In the total cohort of 13,433 patients with 1-year follow-up results, the mean age of patients was 64.7 years, 54% were men. Mean number of antihypertensive drugs was higher in the ALIS group compared to the other groups (3.0 drugs versus 2.5 in ACEI/ARB versus 1.6 in non-RAS; p<0.0001). Statistical regression analysis revealed baseline BP as the dominant covariate. After adjustment for baseline BP and 12 other confounders, no significant differences in BP reduction between the three groups were observed. The rate of major cardiac events (death, myocardial infarction, and stroke) was 1.3% in the total cohort, and did not differ across groups.
ALIS at beginning of the observation was mostly used by the physicians in patients with higher BP at entry and in higher risk populations. By study end, in all groups, stringent BP lowering measures, usually with combination therapy, led to significant improvements; more than half of these at-risk patients reached the BP targets.
关于在临床实践条件下管理的高血压患者的特征和预后的现有数据有限。
3A注册研究是一项在德国初级保健机构中进行的开放性前瞻性观察队列研究，阿利吉仑（ALIS）、ACE抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）或不影响肾素血管紧张素系统的抗高血压药物（非RAS）的纳入比例为4:1:1。使用非线性混合回归模型评估随访期间不同组纳入时不同血压值的血压变化。ClinicalTrial.gov标识符为NCT01454583。在13433例有1年随访结果的患者总队列中，患者的平均年龄为64.7岁，54%为男性。与其他组相比，ALIS组的抗高血压药物平均数量更高（3.0种药物，ACEI/ARB组为2.5种，非RAS组为1.6种；p<0.0001）。统计回归分析显示基线血压是主要协变量。在调整基线血压和其他12个混杂因素后，三组之间的血压降低无显著差异。总队列中的主要心脏事件（死亡、心肌梗死和中风）发生率为1.3%，各组之间无差异。
在观察开始时，ALIS主要被医生用于入组时血压较高的患者和高危人群。到研究结束时，在所有组中，通常采用联合治疗的严格血压降低措施导致了显著改善；超过一半的这些高危患者达到了血压目标。
