最佳抗高血压药物依从性可降低环境温度对脑出血发生的影响：一项病例交叉研究。
Optimal Antihypertensive Medication Adherence Reduces the Effect of Ambient Temperature on Intracerebral Hemorrhage Occurrence: A Case-Crossover Study.
作者信息
Wang Peng, Luo Shuang, Cheng Shuwen, Li Yaxin, Song Weizheng
机构信息
Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China.
West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, People's Republic of China.
出版信息
Patient Prefer Adherence. 2021 Nov 10;15:2489-2496. doi: 10.2147/PPA.S341259. eCollection 2021.
BACKGROUND AND PURPOSE
The role of antihypertensive medication adherence in reducing the effect of ambient temperature (TEM) on intracerebral hemorrhage (ICH) pathogenesis is unclear. We aimed to study the influence of ambient TEM on the ICH occurrence in hypertensive patients with different medication adherence.
METHODS
We enrolled consecutive ICH patients with a definite history of hypertension in a teaching hospital over a period of six years. Medication adherence was calculated using the proportion of prescription days covered (PDC) to antihypertensive mediation in the last month before the ICH attack. Optimal medication adherence (OMA) was the PDC > 80%, and non-optimal medication adherence (non-OMA) was ≤80%. Daily ambient TEM and its variation were collected as the explanatory variables, and dominant air pollutants were gathered as covariates. We adopted a time-stratified case-crossover approach to minimize individual confounders. Conditional logistic regression was conducted to calculate the odds ratio (OR) of daily ambient TEM on ICH occurrence.
RESULTS
We recruited a total of 474 patients in this study. The number of participants with OMA and non-OMA was 249 and 225. Daily mean and max TEM in lag0 to lag2, as well as daily min TEM in lag0 to lag1, were significantly related to ICH onset in all enrolled patients and non-OMA cases. However, only daily TEM in lag0 was meaningfully associated with ICH onset in the OMA cases. The risk of ICH in OMA patients, respectively, changed by 7.9% (OR = 0.921, [0.861, 0.985]) or 6.3% (OR = 0.937, [0.882, 0.995]) when daily mean or max TEM was altered by 1°C in lag0, but the change raised by 10.4% (OR = 0.896, [0.836, 0.960]) or 7.5% (OR = 0.925, [0.868, 0.986]) in non-OMA patients. And the risk varied (OR = 0.933, [0.882, 0.988]) only in non-OMA patients when daily min TEM was altered by 1°C in lag1.
CONCLUSION
Our results indicate that OMA to antihypertensive drugs reduces the influence of ambient TEM on ICH occurrence in hypertensive patients.
背景与目的
抗高血压药物依从性在降低环境温度（TEM）对脑出血（ICH）发病机制影响方面的作用尚不清楚。我们旨在研究环境TEM对不同药物依从性的高血压患者发生ICH的影响。
方法
我们纳入了一家教学医院6年间连续的有明确高血压病史的ICH患者。使用ICH发作前最后一个月抗高血压药物的处方覆盖天数比例（PDC）来计算药物依从性。最佳药物依从性（OMA）为PDC>80%，非最佳药物依从性（非OMA）为≤80%。收集每日环境TEM及其变化作为解释变量，并收集主要空气污染物作为协变量。我们采用时间分层病例交叉方法以尽量减少个体混杂因素。进行条件逻辑回归以计算每日环境TEM对ICH发生的比值比（OR）。
结果
本研究共纳入474例患者。OMA和非OMA参与者的数量分别为249例和225例。在所有纳入患者和非OMA病例中，滞后0至滞后2的每日平均和最高TEM，以及滞后0至滞后1的每日最低TEM与ICH发病显著相关。然而，在OMA病例中，仅滞后0的每日TEM与ICH发病有显著关联。在滞后0时，当日平均或最高TEM每改变1°C，OMA患者发生ICH的风险分别变化7.9%（OR = 0.921，[0.861, 0.985]）或6.3%（OR = 0.937，[0.882, 0.995]），但在非OMA患者中，该变化升高了10.4%（OR = 0.896，[0.836, 0.960]）或7.5%（OR = 0.925，[0.868, 0.986]）。并且在滞后1时，当日最低TEM每改变1°C，仅在非OMA患者中风险有所变化（OR = 0.933，[0.882, 0.988]）。
结论
我们的结果表明，抗高血压药物的OMA可降低环境TEM对高血压患者发生ICH的影响。
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