Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia.
Charles Perkins Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
Heart. 2023 Dec 20;110(2):94-100. doi: 10.1136/heartjnl-2023-322602.
This study explored factors that may influence blood pressure (BP) control in patients with atrial fibrillation (AF) with hypertension.
Cross-sectional retrospective analysis of the MedicineInsight database which includes de-identified electronic health records from general practices (GPs) across Australia. BP control was assessed in patients with diagnosed AF and hypertension (controlled BP defined as <140/90 mm Hg). We explored BP control, factors influencing BP control and likelihood of receiving guideline-recommended treatment.
34 815 patients with AF and hypertension were included; mean age was 76.9 (10.2 SD) years and 46.2% were female. 38.0% had uncontrolled BP. Women (OR 0.72; 95% CI 0.68, 0.76; p<0.001) and adults ≥75 years (OR 0.78; 95% CI 0.70, 0.86; p<0.001) were less likely to have controlled BP. Greater continuity of care (CoC; that is, visits with the same clinician) and having frequent GP visits were associated with higher odds of controlled BP (model 1: CoC, OR 1.29; 95% CI 1.20, 1.40, p<0.001; GP visits, OR 1.71; 95% CI 1.58, 1.85, p<0.001) and a greater likelihood of being prescribed ≥2 types of BP-lowering medicines (model 2: CoC, OR 1.12; 95% CI 1.03, 1.23; p=0.011; GP visits, OR 1.80; 95% CI 1.63, 1.98; p<0.001).
Uncontrolled BP was more likely in women and adults ≥75 years. Patients who had frequent GP visits with the same clinician were more likely to have BP controlled and receive guideline-recommended antihypertensive treatment. This suggests that targeting these primary care factors could potentially improve BP control and subsequently reduce stroke risk in patients with AF.
本研究旨在探讨可能影响高血压合并心房颤动（AF）患者血压控制的因素。
这是一项对澳大利亚全科医生（GP）电子健康记录进行的 MedicineInsight 数据库的横断面回顾性分析。将血压控制定义为<140/90mmHg，评估诊断为 AF 和高血压的患者的血压控制情况。我们探讨了血压控制、影响血压控制的因素以及接受指南推荐治疗的可能性。
共纳入 34815 例高血压合并 AF 的患者，平均年龄为 76.9（10.2SD）岁，46.2%为女性。38.0%的患者血压未得到控制。女性（比值比 0.72；95%置信区间 0.68，0.76；p<0.001）和≥75 岁的成年人（比值比 0.78；95%置信区间 0.70，0.86；p<0.001）血压控制的可能性较小。较高的连续性护理（CoC；即与同一位临床医生的就诊次数）和频繁的 GP 就诊与血压控制的可能性更高相关（模型 1：CoC，比值比 1.29；95%置信区间 1.20，1.40，p<0.001；GP 就诊，比值比 1.71；95%置信区间 1.58，1.85，p<0.001），并且更有可能开≥2 种降压药物（模型 2：CoC，比值比 1.12；95%置信区间 1.03，1.23；p=0.011；GP 就诊，比值比 1.80；95%置信区间 1.63，1.98；p<0.001）。
女性和≥75 岁的成年人更有可能血压未得到控制。与同一位 GP 就诊次数较多的患者，更有可能控制血压并接受指南推荐的降压治疗。这表明，针对这些初级保健因素可能有助于提高血压控制，从而降低 AF 患者的中风风险。
