1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Kardiol Pol. 2018;76(2):353-361. doi: 10.5603/KP.a2017.0211. Epub 2017 Nov 13.
Identification of factors interfering with adequate control of arterial hypertension (HT) in the course of antihypertensive therapy is necessary to reduce the incidence of cardiovascular disorders and optimise clinical practice guidelines.
The study objective was to conduct a screening assessment of the rate of uncontrolled hypertension among hypertensive patients coming to a routine follow-up visit, and to characterise patients with inadequate control of HT in the aspect of their cardiovascular risk profile and therapeutic strategies used.
The CONTROL NT registry was a nationwide observational study performed by physicians in the outpatient setting in Poland. Patient data were collected twice: between April and September 2011 and between January and August 2012. Dur-ing screening, the physician completed a questionnaire with patient basic clinical information. The impact of the selected demographic and clinical parameters on treatment success defined as blood pressure (BP) lowering to < 140/90 mmHg when measured in the office at the second visit was investigated with univariate and multivariate logistic regression models.
In total 1288 outpatient physicians participated in the CONTROL NT registry. In the screened group of 34,919 patients with a history of HT, 66.9% had abnormal BP readings in the office. In 15,262 patients with inadequate control of hypertension included in further analysis, the mean age was 59.3 ± 11.9 years, 47.9% were women, the disease duration was 8.2 ± 6.5 years and antihypertensive therapy was used for 7.4 ± 6.0 years. At least three cardiovascular risk factors were found in 46% of patients, with the most common dyslipidaemia (77.4%) and abdominal obesity (74.8%). In 56.6% of patients at least one concomitant disease was diagnosed, the most common being diabetes (29.8%). At the time of enrolment 21.5% of patients received no antihypertensive drugs, one, two, three (or more) drug combinations and fixed-dose combina-tions were received by 16.8%, 28.5%, 31.5% and 4.0% of patients, respectively. The most commonly used drug class was angiotensin-converting enzyme inhibitors (50%), followed by beta-blockers (42%) and diuretics (39%). Significant negative predictors of BP control included: body mass index ≥ 30 kg/m², heart rate ≥ 70 bpm, history of hypertension ≥ 7 years, and kidney disease (the odds ratios adjusted by age and gender - 0.61; 0.76; 0.79; and 0.76, respectively).
The percentage of Polish outpatients with adequate HT control is unsatisfactory. Patients with diabetes, chronic kidney disease, dyslipidaemia, overweight or obesity, longer disease and treatment duration and poor treatment compliance require a particularly careful assessment of risk factors and comorbidities, appropriate therapy intensification, and more frequent use of antihypertensive fixed-dose combinations.
识别在降压治疗过程中干扰动脉高血压（HT）充分控制的因素对于降低心血管疾病的发生率和优化临床实践指南是必要的。
本研究的目的是对常规随访就诊的高血压患者中未控制的高血压发生率进行筛查评估，并从心血管风险状况和所用治疗策略方面对HT控制不佳的患者进行特征描述。
CONTROL NT 登记研究是一项由波兰门诊医生进行的全国性观察性研究。两次收集患者数据：2011 年 4 月至 9 月和 2012 年 1 月至 8 月。在筛查期间，医生填写一份包含患者基本临床信息的问卷。使用单变量和多变量逻辑回归模型研究了所选人口统计学和临床参数对治疗成功的影响，治疗成功定义为第二次就诊时诊室血压（BP）降至<140/90mmHg。
共有 1288 名门诊医生参与了 CONTROL NT 登记研究。在既往有 HT 史的 34919 例患者的筛查组中，66.9%的患者办公室 BP 读数异常。在进一步分析中纳入的 15262 例高血压控制不佳的患者中，平均年龄为 59.3±11.9 岁，47.9%为女性，疾病病程为 8.2±6.5 年，降压治疗持续时间为 7.4±6.0 年。46%的患者至少存在 3 个心血管危险因素，最常见的是血脂异常（77.4%）和腹部肥胖（74.8%）。在 56.6%的患者中诊断出至少一种合并症，最常见的是糖尿病（29.8%）。在入组时，21.5%的患者未接受任何降压药物治疗，分别有 16.8%、28.5%、31.5%和 4.0%的患者接受了一种、两种、三种（或更多）药物联合治疗和固定剂量联合治疗。最常用的药物类别是血管紧张素转换酶抑制剂（50%），其次是β受体阻滞剂（42%）和利尿剂（39%）。血压控制的显著负预测因素包括：体重指数≥30kg/m²、心率≥70 次/分、高血压病史≥7 年和肾脏疾病（经年龄和性别调整后的比值比分别为 0.61、0.76、0.79 和 0.76）。
波兰门诊患者 HT 控制率不理想。糖尿病、慢性肾脏病、血脂异常、超重或肥胖、更长的疾病和治疗持续时间以及较差的治疗依从性的患者需要特别仔细评估危险因素和合并症，适当强化治疗，并更频繁地使用降压固定剂量联合治疗。
