Holmquist Charlotte, Hasselström Jan, Bengtsson Boström Kristina, Manhem Karin, Wettermark Björn, Hjerpe Per, Kahan Thomas
aDepartment of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm bR&D Centre Skaraborg Primary Care, Skövde cDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg dDepartment of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet ePublic Healthcare Services Committee, Stockholm County Council fDivision of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
J Hypertens. 2017 Oct;35(10):2102-2108. doi: 10.1097/HJH.0000000000001429.
To study temporal trends in hypertension treatment and control in Swedish primary care, in relation to clinical characteristics, comorbidity, and drug treatment.
Repeated cross-sectional analysis of 43 239 hypertensive patients attending primary care in 2001-2002 and of 62 407 patients in 2007-2008.
Mean blood pressure (BP) 2007-2008 was 143/79 mmHg in women and 142/81 mmHg in men. Cardiovascular comorbidity and diabetes were present in 13 and 15% of women, and in 18 and 20% of men. Overall BP reductions from 2001-2002 to 2007-2008 were 9.0/3.1 mmHg; greater in women than men, with advancing age, and in patients with comorbidity (all P < 0.001). Attainment of target BP (<140/90 mmHg) increased from 24 and 26% in women and men (2001-2002) to 37 and 37% (2007-2008; all P < 0.001). Most common drug classes in 2001-2002 were, in descending frequency, β blockers, diuretics, and calcium channel blockers (both sexes), and in 2007-2008 β blockers, diuretics, and angiotensin-converting enzyme inhibitors in women, and β blockers, angiotensin-converting enzyme inhibitors, and diuretics in men. The number of drug classes/patient increased from 1.5 (2001-2002) to 1.8 (2007-2008; P < 0.001) but remained low (1.7) in those above target BP.
BP control in hypertensive patients attending Swedish primary care has improved over 5-7 years, and more so in high-risk groups. There is, however, room for improvement. In uncontrolled hypertension the combination of several drug classes remain low.
研究瑞典初级保健中高血压治疗与控制的时间趋势，并分析其与临床特征、合并症及药物治疗的关系。
对2001 - 2002年就诊于初级保健机构的43239例高血压患者以及2007 - 2008年的62407例患者进行重复横断面分析。
2007 - 2008年女性平均血压（BP）为143/79 mmHg，男性为142/81 mmHg。13%的女性和18%的男性存在心血管合并症，15%的女性和20%的男性患有糖尿病。从2001 - 2002年到2007 - 2008年，总体血压降幅为9.0/3.1 mmHg；女性降幅大于男性，随年龄增长而增大，且在合并症患者中降幅更大（均P < 0.001）。血压达标（<140/90 mmHg）的比例从女性和男性的24%和26%（2001 - 2002年）升至37%和37%（2007 - 2008年；均P < 0.001）。2001 - 2002年最常用的药物类别按频率从高到低依次为β受体阻滞剂、利尿剂和钙通道阻滞剂（男女皆是），2007 - 2008年女性为β受体阻滞剂、利尿剂和血管紧张素转换酶抑制剂，男性为β受体阻滞剂、血管紧张素转换酶抑制剂和利尿剂。每位患者使用的药物类别数量从1.5种（2001 - 2002年）增至1.8种（2007 - 2008年；P < 0.001），但血压未达标的患者中该数量仍较低（1.7种）。
在5 - 7年期间，瑞典初级保健中高血压患者的血压控制情况有所改善，高危人群改善更为明显。然而，仍有改进空间。在血压未得到控制的患者中，联合使用多种药物类别的情况仍然较少。
