Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Cardiol. 2022 Apr 1;352:137-143. doi: 10.1016/j.ijcard.2022.02.014. Epub 2022 Feb 14.
Hypertension is a modifiable risk factor in patients at the highest risk for cardiovascular events. New invasive treatment options are becoming available that might be particularly appealing for high-risk patients. Therefore, the aim of this study was to determine the prevalence of high-risk patients on routine therapy that do not meet guideline recommended ambulatory blood pressure (ABP) targets.
This single-center, cross-sectional study was conducted at the Erasmus University Medical Center (Rotterdam, The Netherlands). Inclusion criteria were: (1) age 18-80 years, (2) drugs prescribed for hypertension or history of hypertension and (3) high cardiovascular risk as defined according to the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines. Patients underwent standardized office blood pressure (OBP) and same-day 24-h ABP measurements. Blood pressure (BP) control was defined according to the 2018 ESC/ESH and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines.
A total of 100 patients were enrolled (median age 71 years, 35% female). Mean OBP was 142.2/81.9 ± 18.6/12.6 mmHg and mean 24-h ABP was 126.1/70.1 ± 14.3/9.2 mmHg. Patients were on 2.0 [25th-75th percentile: 1.0-3.3] Defined Daily Doses of antihypertensive drugs. ESC/ESH guideline 24-h ABP and OBP targets were not met in 41.8% (95%CI: 31.5-52.6%) and 52.7% (95%CI: 42.0-63.3%), respectively. ACC/AHA guideline 24-h ABP and OBP targets were not met in 59.3% (95%CI: 48.5-69.5%) and 79.1% (95%CI: 69.3-86.9%), respectively.
BP remains uncontrolled in 40-60% of high-risk hypertensive patients despite routine use of guideline-recommended therapy. Our findings support the search towards novel invasive BP lowering treatment options.
高血压是心血管事件高危患者的可改变风险因素。新的侵入性治疗选择正在出现，这对高危患者可能特别有吸引力。因此，本研究的目的是确定在接受常规治疗的高危患者中，有多少患者的血压未达到指南推荐的动态血压（ABP）目标。
这项单中心、横断面研究在伊拉斯谟大学医学中心（荷兰鹿特丹）进行。纳入标准为：（1）年龄 18-80 岁，（2）开有治疗高血压的药物或有高血压病史，（3）根据欧洲心脏病学会/欧洲高血压学会（ESC/ESH）指南定义的高心血管风险。患者接受标准化诊室血压（OBP）和同日 24 小时 ABP 测量。血压（BP）控制根据 2018 ESC/ESH 和 2017 年美国心脏病学会/美国心脏协会（ACC/AHA）指南定义。
共纳入 100 例患者（中位年龄 71 岁，35%为女性）。平均 OBP 为 142.2/81.9 ± 18.6/12.6 mmHg，平均 24 小时 ABP 为 126.1/70.1 ± 14.3/9.2 mmHg。患者服用 2.0 [25-75 百分位：1.0-3.3]定义日剂量的抗高血压药物。ESC/ESH 指南 24 小时 ABP 和 OBP 目标的未达标率分别为 41.8%（95%CI：31.5-52.6%）和 52.7%（95%CI：42.0-63.3%）。ACC/AHA 指南 24 小时 ABP 和 OBP 目标的未达标率分别为 59.3%（95%CI：48.5-69.5%）和 79.1%（95%CI：69.3-86.9%）。
尽管常规使用指南推荐的治疗方法，但仍有 40-60%的高危高血压患者血压未得到控制。我们的研究结果支持寻找新的侵入性降压治疗选择。
