Bharatia Rajkumar, Chitale Manoj, Saxena Ganesh Narain, Kumar Raman Ganesh, Trailokya Abhijit, Dalvi Kalpesh, Talele Suhas
The Apollo Clinic, Guwahati, Assam.
Consultant, Shree Clinic, Nashik, Maharashtra.
J Assoc Physicians India. 2016 Jul;64(7):14-21.
Hypertension (HTN), being a major risk factor for cardiovascular diseases (CVDs), is an important issue of medical and public health. High blood pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in south Asia (2010). Hypertension (HTN) exerts a substantial public health burden on cardiovascular health status and healthcare systems in India. Uncontrolled hypertension among adults with hypertension is associated with increased mortality. An inadequate data is available in India on uncontrolled hypertension.
The present study was planned to evaluate the patient profile, co-morbidities, management in uncontrolled hypertensive patients and also to determine the number of patients with resistant hypertension across India.
A total of 4725 uncontrolled hypertensive patients who were on anti-hypertensive medications were evaluated in this cross-sectional and observational study. The observed patterns were recorded with respect to the prevalence of uncontrolled hypertension and evaluate the socio-demographic, medical history, anthropometric variables and treatment preferences in Indian patients with uncontrolled hypertension.
Majority of the patients with uncontrolled hypertension were males (71.4%) and aged 46-65 years. Most of the study population were pre-obese (males: 35.7%; females: 27.4%). Higher proportion of patients with uncontrolled hypertension were residents of Maharashtra (25.6%) and Gujarat (11.6%). Antihypertensive monotherapy was used by 45.4% and 54.6% patients used combination therapy (≥ 2 categories of anti-hypertensive medications). Angiotensin receptor blockers (ARBs) were the most preferred agent as monotherapy (70.6%) and also the most common component of dual and triple combination anti-hypertensive agent. 19.5% (922/4725) patients had resistant hypertension and 80% of the patients were aged 46-65 years. Higher proportion of patients were males (67.2%; 620/922) and higher proportion of patients were to residents of Andhra Pradesh (21.4% patients) and Maharashtra (19.3% patients). All 922 resistant hypertensive patients were on ≥ 3 anti-hypertensive medications and received ARB + CCB + Diuretics as the most preferred anti-hypertensive combination therapy. Diabetes and dyslipidaemia were the major comorbidities reported in patients with uncontrolled and resistant hypertension. Lipid lowering agents followed by oral hypoglycaemic agents and antiplatelet medications were the common concomitant medications used. Various factor responsible for not achieving the desired blood pressure goals may be the physician's lack of awareness about recent hypertensive treatment guidelines that might contribute to patient's poor adherence due to not explaining adequately the benefit and risks of a medication, not giving consideration to the patient's life style, the cost of medication, and inadequate dose titration.
Uncontrolled hypertension is a major problem in India. It is prudent to focus on multiple risk factors while treating hypertension. A combination therapy with multiple blood pressure lowering drugs are important and concerns should be identified while selecting the appropriate dosage of combinations of anti-hypertensive therapy and adherence to the therapy. The preferred choices for mono, dual combination and triple combination anti-hypertensive regimens are ARBs; ARB + CCB; ARB + CCB + Diuretics, respectively. In this study, most of the patients were on monotherapy; however a rationale combination therapy or dose adjustment is required for the effective management of hypertension. The protective measures to be taken to control hypertension includes reduction of physicians inertia, diet and physical activity, regular patient follow-up with BP measurements and counselling, and the improvement in patient adherence.
高血压作为心血管疾病的主要危险因素，是医学和公共卫生领域的重要问题。高血压在南亚地区（2010年）被列为疾病归因负担的第三大重要危险因素。高血压给印度的心血管健康状况和医疗系统带来了沉重的公共卫生负担。高血压成年人中未得到控制的高血压与死亡率增加相关。印度关于未得到控制的高血压的数据不足。
本研究旨在评估未得到控制的高血压患者的特征、合并症、管理情况，并确定印度各地难治性高血压患者的数量。
在这项横断面观察性研究中，对4725名正在服用抗高血压药物的未得到控制的高血压患者进行了评估。记录观察到的关于未得到控制的高血压患病率的模式，并评估印度未得到控制的高血压患者的社会人口统计学、病史、人体测量学变量和治疗偏好。
未得到控制的高血压患者中大多数为男性（71.4%），年龄在46 - 65岁之间。大多数研究人群为肥胖前期（男性：35.7%；女性：27.4%）。未得到控制的高血压患者中较高比例是马哈拉施特拉邦（25.6%）和古吉拉特邦（11.6%）的居民。45.4%的患者使用抗高血压单药治疗，54.6%的患者使用联合治疗（≥2类抗高血压药物）。血管紧张素受体阻滞剂（ARBs）是最常用的单药治疗药物（70.6%），也是双联和三联抗高血压联合药物中最常见的成分。19.5%（922/4725）的患者患有难治性高血压，其中80%的患者年龄在46 - 65岁之间。较高比例的患者为男性（67.2%；620/922），较高比例的患者是安得拉邦（21.4%的患者）和马哈拉施特拉邦（19.3%的患者）的居民。所有922名难治性高血压患者都服用≥3种抗高血压药物，最常用的抗高血压联合治疗方案是ARB + CCB + 利尿剂。糖尿病和血脂异常是未得到控制和难治性高血压患者报告的主要合并症。常用的伴随药物依次为降脂药、口服降糖药和抗血小板药物。未能达到理想血压目标的各种因素可能包括医生对最新高血压治疗指南缺乏认识，这可能导致患者依从性差，原因是没有充分解释药物的益处和风险、没有考虑患者的生活方式、药物成本以及剂量滴定不足。
未得到控制的高血压在印度是一个主要问题。治疗高血压时关注多个危险因素是明智的。多种降压药物的联合治疗很重要，在选择抗高血压治疗联合用药的合适剂量以及确保治疗依从性时应识别相关问题。单药、双联和三联抗高血压治疗方案的首选药物分别是ARBs；ARB + CCB；ARB + CCB + 利尿剂。在本研究中，大多数患者采用单药治疗；然而，为有效管理高血压，需要合理的联合治疗或剂量调整。控制高血压应采取的保护措施包括减少医生的惰性、调整饮食和进行体育活动、定期对患者进行血压测量随访和咨询，以及提高患者的依从性。
