Sharma Ranjan Kumar, Verma Manish, Tiwari Ravi M, Joshi Abhay, Trivedi Chirag A, Chodankar Deepa R
Department of Cardiology, Nil Ratan Sircar Medical College and Hospital, 138, Acharya Jagadish Chandra Bose Road, Kolkata, West Bengal 700014, India.
Sanofi House, No 117-B, L & T Business Park, Saki Vihar Road, Powai, Mumbai, Maharashtra 400072, India.
Indian Heart J. 2018 Dec;70 Suppl 3(Suppl 3):S213-S220. doi: 10.1016/j.ihj.2018.11.013. Epub 2018 Dec 8.
To assess the prevalence of high central aortic pressure (CAP) in Indian patients with uncontrolled essential hypertension while on anti-hypertensive monotherapy. Also, to determine correlation between brachial blood pressure (BBP) and CAP, and ascertain if it is impacted by anti-hypertensive drug class and patients' age.
In this real-world, observational, prospective study, patients (30-70 years) with uncontrolled BBP (systolic BP [SBP] ≥140 mmHg or diastolic BP [DBP] ≥90 mmHg) were enrolled. Treatment was adjusted at Visit 1 (baseline), based on BBP and at treating physicians' discretion. Primary endpoint was proportion of patients with uncontrolled central aortic SBP (>125 mmHg) at baseline. Secondary endpoints were comparison of BBP and CAP across drugs classes and age groups at baseline and Visit 2 (End-of-study, ∼8 weeks post-baseline), and proportion of patients with uncontrolled central SBP at end-of-study.
Of 2030 patients screened, 1949 patients reported at baseline and 1740 patients completed end-of-study visit. Central SBP was >125 mmHg for 84.3% patients at baseline, and 48% patients at end-of-study. Interestingly, at end-of-study, 6.6% patients still had uncontrolled brachial SBP and controlled central SBP, while 13.6% patients had uncontrolled central SBP and controlled brachial SBP. At both visits, brachial SBP and central SBP showed positive correlation across most drug classes and age groups. At baseline, ACE inhibitors showed better efficacy than other drug classes. At end-of-study, BP control was better with fixed-dose combinations, though free-drug combinations were more frequently prescribed.
Measurement of CAP along with BBP can be vital in management of hypertension.
CTRI/2015/10/006302.
评估接受抗高血压单药治疗但血压控制不佳的印度原发性高血压患者中高中心动脉压（CAP）的患病率。此外，确定肱动脉血压（BBP）与CAP之间的相关性，并确定其是否受抗高血压药物类别和患者年龄的影响。
在这项真实世界、观察性、前瞻性研究中，纳入了血压控制不佳（收缩压[SBP]≥140 mmHg或舒张压[DBP]≥90 mmHg）的30至70岁患者。在第1次就诊（基线）时，根据肱动脉血压并由治疗医生酌情调整治疗方案。主要终点是基线时中心动脉收缩压未得到控制（>125 mmHg）的患者比例。次要终点是在基线和第2次就诊（研究结束时，基线后约8周）时，比较不同药物类别和年龄组的肱动脉血压和中心动脉压，以及研究结束时中心动脉收缩压未得到控制的患者比例。
在筛查的2030例患者中，1949例患者在基线时报到，1740例患者完成了研究结束时的就诊。基线时，84.3%的患者中心动脉收缩压>125 mmHg，研究结束时为48%。有趣的是，在研究结束时，6.6%的患者肱动脉收缩压未得到控制但中心动脉压得到控制，而13.6%的患者中心动脉压未得到控制但肱动脉收缩压得到控制。在两次就诊时，大多数药物类别和年龄组的肱动脉收缩压和中心动脉收缩压均呈正相关。在基线时, 血管紧张素转换酶抑制剂显示出比其他药物类别更好的疗效。在研究结束时，固定剂量组合的血压控制效果更好，尽管自由联合用药的处方频率更高。
同时测量肱动脉血压和中心动脉压对于高血压的管理可能至关重要。
CTRI/2015/10/006302。
