König Maximilian, Gollasch Maik, Rosada Adrian, Demuth Ilja, Spira Dominik, Steinhagen-Thiessen Elisabeth
Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Berlin, Berlin Institute of Health, Berlin, Germany.
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
Drugs Aging. 2018 Nov;35(11):993-1003. doi: 10.1007/s40266-018-0580-0.
Hypertension is highly prevalent in older adults and represents a major public health issue since recognition, awareness, treatment and control are insufficient. Analyses of prescription patterns in conjunction with clinical parameters can provide novel insights into the current practice of hypertension management and help to identify barriers to sufficient hypertension control.
A cross-sectional analysis was conducted. Prevalence of hypertension, patterns of antihypertensive therapy, and determinants of blood pressure (BP) control were examined in the Berlin Aging Study II cohort, including 1654 community-dwelling older adults (60-85 years of age).
Of the participants, 75.9% had hypertension; 40.6% of these were not prescribed BP medications. Lack of hypertension awareness, younger age, absence of comorbidities, not being on a statin, and not having visited a physician in the past 3 months were associated with lack of treatment. Forty-two percent of treated hypertensive individuals received monotherapy and 58.0% received combination therapy. Renin-angiotensin-aldosterone system (RAAS) inhibitors, and β-blockers were most commonly prescribed, while calcium channel blockers were least prescribed. Only 38.5% of treated hypertensive individuals had their BP controlled to < 140/90 mmHg. Number and choice of BP medications were not predictive of BP control; neither were age, glycated hemoglobin (HbA), kidney function, or number of healthcare visits. However, female sex, lower low-density lipoprotein cholesterol (LDL-C) levels and current smoking, amongst others, were positively associated with BP control. There was evidence of significant effect modification by statins in the association of LDL-C and BP.
The majority of older adults do not reach BP goals. Antihypertensive prescription patterns do not conform to current guidelines. Using more BP medications was not associated with higher odds of BP control. Lowering LDL-C might be favorable in terms of BP control.
高血压在老年人中极为普遍，鉴于其识别、知晓、治疗和控制情况均不充分，这已成为一个重大的公共卫生问题。结合临床参数对处方模式进行分析，可为当前高血压管理实践提供新的见解，并有助于识别充分控制高血压的障碍。
进行了一项横断面分析。在柏林衰老研究II队列中，对1654名社区居住的老年人（60 - 85岁）进行了高血压患病率、降压治疗模式以及血压（BP）控制决定因素的检查。
参与者中，75.9%患有高血压；其中40.6%未开具降压药物。缺乏高血压知晓、年龄较轻、无合并症、未服用他汀类药物以及在过去3个月内未就医与未接受治疗有关。42%接受治疗的高血压患者接受单药治疗，58.0%接受联合治疗。肾素 - 血管紧张素 - 醛固酮系统（RAAS）抑制剂和β受体阻滞剂是最常用的处方药物，而钙通道阻滞剂的处方最少。仅38.5%接受治疗的高血压患者血压控制在<140/90 mmHg。降压药物的数量和选择不能预测血压控制情况；年龄、糖化血红蛋白（HbA）、肾功能或就医次数也不能预测。然而女性、较低的低密度脂蛋白胆固醇（LDL - C）水平以及当前吸烟等因素与血压控制呈正相关。有证据表明他汀类药物在LDL - C与血压的关联中存在显著的效应修饰作用。
大多数老年人未达到血压目标。降压处方模式不符合当前指南。使用更多的降压药物与血压控制的较高几率无关。降低LDL - C可能有利于血压控制。
