Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 17, 1011, Lausanne, Switzerland.
Pharmacol Res. 2017 Nov;125(Pt B):142-149. doi: 10.1016/j.phrs.2017.08.015. Epub 2017 Sep 1.
Blood pressure control remains unsatisfactory in all countries of the world with at best 60% of treated hypertensive patients reaching recommended therapeutic goals. Several factors have been identified which may explain why the rate of blood pressure control remains low. Among them, one can cite medical inertia and a poor adherence to drug therapies. In the absence of new drugs to control blood pressure, drug adherence has become a major issue in the management of hypertensive patients. Numerous studies have demonstrated that the major problem is the lack of persistence followed by a poor day to day execution of the prescribed regimens. Although there are multiple ways of assessing drug adherence, only very few of them are accurate and the most accurate ones are either difficult to implement in clinical practice or too expensive and hence not available outside reference centers. Therefore, physicians have no real capacity to establish a correct diagnosis of non persistence or poor adherence even in high risk patients such as those with resistant hypertension. Today a new approach is becoming increasingly used which consists in measuring urinary drug levels. Nevertheless, there is still an important need for simple and cheap techniques or devices helping physicians in their ability to tackle poor adherence to therapy and thereby improve blood pressure control in the population.
血压控制在世界各国仍不尽如人意，最好的情况下也只有 60%的高血压患者达到了推荐的治疗目标。有几个因素可能解释了为什么血压控制率仍然很低。其中，可以举出医疗惰性和对药物治疗的依从性差。在没有新的降压药物的情况下，药物依从性已成为高血压患者管理中的一个主要问题。大量研究表明，主要问题是缺乏持久性，随后是处方方案的日常执行不佳。尽管有多种评估药物依从性的方法，但只有很少的方法是准确的，而最准确的方法要么难以在临床实践中实施，要么过于昂贵，因此在参考中心之外无法获得。因此，即使是在高危患者（如耐药性高血压患者）中，医生也无法真正确定非持久性或药物依从性差的正确诊断。如今，一种新的方法越来越被使用，即测量尿液中的药物水平。然而，仍然需要简单廉价的技术或设备来帮助医生处理治疗依从性差的问题，从而改善人群中的血压控制。
