Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Hallym University Pyeongchon Sacred Heart Hospital, Anyang, Republic of Korea.
J Clin Hypertens (Greenwich). 2020 Aug;22(8):1415-1424. doi: 10.1111/jch.13941. Epub 2020 Jul 11.
We sought to investigate the psychosocial characteristics of patients with uncontrolled hypertension and examine factors that influence blood pressure (BP) control. A total of 1011 patients with uncontrolled hypertension were enrolled in 13 tertiary hospitals. Uncontrolled hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg despite on antihypertensive therapy. Socio-demographics, anthropometrics, behavioral risk factors, medication pattern, adherence, and measures of health-related quality of life (HRQoL; EuroQol 5D visual analog scale [EQ-5D VAS]) were assessed at baseline and during follow-up visits (3 and 6 months). Patients were divided into 2 groups based on BP control status at 6 months (controlled group [n = 532] vs uncontrolled group [n = 367]). There were no differences in clinical characteristics except the proportion of smokers and baseline BP between patients with controlled BP and uncontrolled BP. At 6 months, the adherence of antihypertensive medication did not differ between the groups but the proportion of combination therapy with ≥3 antihypertensives was significantly higher in patients with uncontrolled BP. EQ-5D VAS at follow-up was significantly lower in patients with uncontrolled BP despite similar baseline values. Multivariate logistic regression analysis revealed that EQ-5D VAS at follow-up significantly correlated with BP control. Patients with worse HRQoL had higher Charlson Comorbidity Index and higher proportion of taking ≥3 antihypertensives, but medication adherence was similar to those with better HRQoL. These findings suggest that along with pharmacologic intervention of hypertension, management of comorbid conditions or psychological support might be helpful for optimizing BP control in patients with uncontrolled hypertension.
我们旨在探讨血压控制不佳的高血压患者的社会心理特征，并研究影响血压控制的因素。共纳入 13 家三级医院的 1011 例血压控制不佳的高血压患者。血压控制不佳定义为尽管接受降压治疗，但收缩压≥140mmHg 或舒张压≥90mmHg。在基线和随访（3 个月和 6 个月）时评估社会人口统计学、人体测量学、行为危险因素、药物模式、依从性和健康相关生活质量（HRQoL；EuroQol 5D 视觉模拟量表[EQ-5D VAS]）的指标。根据 6 个月时的血压控制情况将患者分为两组（控制组[n=532]与未控制组[n=367]）。除了吸烟者比例和基线血压外，两组间的临床特征无差异。在 6 个月时，两组间降压药物的依从性无差异，但血压未控制组联合使用≥3 种降压药的比例显著更高。尽管基线值相似，但血压未控制组的随访时 EQ-5D VAS 明显更低。多变量逻辑回归分析显示，随访时的 EQ-5D VAS 与血压控制显著相关。HRQoL 较差的患者Charlson 合并症指数更高，服用≥3 种降压药的比例更高，但与 HRQoL 较好的患者相比，其药物依从性相似。这些发现表明，除了高血压的药物干预外，合并症的管理或心理支持可能有助于优化血压控制不佳的高血压患者的血压控制。
