Odaguchi Naoyuki, Sakima Atsushi, Yara Tomohiro, Shiroma Isao
Blood Purification Center, Keiaikai Chibana Clinic, Okinawa, Japan.
Health Administration Center, University of the Ryukyus, Okinawa, Japan.
JMA J. 2022 Jan 17;5(1):74-82. doi: 10.31662/jmaj.2021-0146. Epub 2021 Dec 15.
The current guidelines for managing hypertension recommend strict blood pressure (BP) control to prevent bleeding complications in patients with hypertension on antithrombotic therapy. However, the target BP value of <130/80 mmHg is achieved in a small proportion of these patients. This study aimed to examine the factors associated with nonachievement of target BP value (≥130/80 mmHg) in patients on antithrombotic therapy.
This retrospective study was conducted at an outpatient clinic in 2018. Clinical parameters were obtained from the center's electronic medical database. Office BP was measured once in the sitting position. A target BP value of <130/80 mmHg was defined according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2019.
Of the 26,803 outpatients who had scheduled visits during this time, 2,427 received antithrombotic therapy. Patients with chronic kidney disease stage 5 or on hemodialysis and those with missing data on body mass index were excluded from the study; eventually, 2,201 outpatients met the inclusion criteria. BP values of <140/90 mmHg were observed in 59.2% of these outpatients; however, only 30.6% displayed the target BP value of <130/80 mmHg. Univariate and multivariate logistic regression analyses indicated that male gender and obesity significantly correlated with nonachievement of the target BP (≥130/80 mmHg). However, heart failure and ischemic heart disease were negatively but significantly related to nonachievement of the target BP.
The target BP value was achieved in only a small proportion of the patients treated with antithrombotic drugs. In patients on antithrombotic therapy, obesity appeared to be a modifiable risk factor, whereas cardiovascular comorbidities, such as heart failure, were negative factors contributing to nonachievement of the target BP.
当前高血压管理指南建议严格控制血压（BP），以预防接受抗血栓治疗的高血压患者出现出血并发症。然而，这些患者中只有一小部分能达到<130/80 mmHg的目标血压值。本研究旨在探讨接受抗血栓治疗的患者未达到目标血压值（≥130/80 mmHg）的相关因素。
本回顾性研究于2018年在一家门诊诊所进行。临床参数从该中心的电子医疗数据库中获取。在坐位测量一次诊室血压。根据2019年日本高血压学会高血压管理指南，将目标血压值定义为<130/80 mmHg。
在此期间安排就诊的26803名门诊患者中，2427人接受了抗血栓治疗。排除慢性肾脏病5期或接受血液透析的患者以及体重指数数据缺失的患者；最终，2201名门诊患者符合纳入标准。这些门诊患者中59.2%的血压值<140/90 mmHg；然而，只有30.6%的患者达到了<130/80 mmHg的目标血压值。单因素和多因素逻辑回归分析表明，男性和肥胖与未达到目标血压（≥130/80 mmHg）显著相关。然而，心力衰竭和缺血性心脏病与未达到目标血压呈负相关但具有显著相关性。
接受抗血栓药物治疗的患者中只有一小部分达到了目标血压值。在接受抗血栓治疗的患者中，肥胖似乎是一个可改变的危险因素，而心血管合并症，如心力衰竭，则是导致未达到目标血压的负面因素。
