Department of Medicine, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India.
Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Indian J Med Res. 2023 Sep;158(3):244-255. doi: 10.4103/ijmr.ijmr_3096_21.
BACKGROUND & OBJECTIVES: In India, hypertension constitutes a significant health burden. This observational, non-interventional, prospective study was conducted in five centres across India to evaluate the current clinical practices for the management of hypertension.
Participants were enrolled if they were newly diagnosed with essential hypertension or had pre-existing hypertension and were on the same therapeutic plan for the previous three months. At baseline, three months, six months, and one year, information on the patient and their treatment regimen was documented, and their quality of life (QoL) was evaluated.
A total of 2000 individuals were enrolled in this study, with a mean age of 54.45 yr. Of these, 55.7 per cent (n=1114) were males, and 957 (47.85%) were newly diagnosed with hypertension, while 1043 (52.15%) had pre-existing hypertension. Stage 2 hypertension (systolic blood pressure (BP) >140 or diastolic BP ≥90 mmHg) accounted for more than 70 per cent of the participants (70.76% of pre-existing and 76.29% of newly diagnosed); the average duration of pre-existing hypertension was 68.72 months. Diabetes (31.6%) and dyslipidaemia (15.8%) were the most common comorbidities. In 43.3 per cent of the participants, monotherapy was used, and in 56.7 per cent (70.55% fixed-dose combination), combination therapy was used. Telmisartan (31.6%), amlodipine (35.2%), and a combination of the two (27.1%) were the most commonly prescribed treatment regimens. At three months, six months, and one year, treatment modifications were observed in 1.4, 1.05, and 0.23 per cent of the participants receiving monotherapy and 2.74, 4.78 and 0.35 per cent receiving combination therapy, respectively. In both groups, the proportion of individuals with controlled hypertension (≤140/90 mmHg) increased by more than 30 per cent after a year. At one year, physical and emotional role functioning, social functioning, and health improved considerably.
INTERPRETATION & CONCLUSIONS: Combination therapy for hypertension is increasingly preferred at the time of initial diagnosis. The efficacy, safety, and tolerance of the recommended medications were reflected by improvements in the QoL and the minimal changes in the therapeutic strategy required.
在印度,高血压是一个重大的健康负担。本项观察性、非干预性、前瞻性研究在印度的五个中心进行,旨在评估目前高血压管理的临床实践情况。
如果患者新诊断为原发性高血压或患有原发性高血压且在过去三个月内采用相同的治疗方案,则将其纳入本研究。在基线、三个月、六个月和一年时,记录患者及其治疗方案的信息,并评估其生活质量(QoL)。
本研究共纳入 2000 名患者,平均年龄为 54.45 岁。其中,55.7%(n=1114)为男性,957 名(47.85%)为新诊断的高血压患者,1043 名(52.15%)为患有原发性高血压的患者。2 级高血压(收缩压(BP)>140mmHg 或舒张压≥90mmHg)占比超过 70%(新诊断患者占 76.29%,原有患者占 70.76%);原有高血压的平均病程为 68.72 个月。糖尿病(31.6%)和血脂异常(15.8%)是最常见的合并症。43.3%的患者采用单药治疗,56.7%(70.55%为固定剂量联合治疗)采用联合治疗。替米沙坦(31.6%)、氨氯地平(35.2%)和两者联合(27.1%)是最常用的治疗方案。在接受单药治疗的患者中,分别有 1.4%、1.05%和 0.23%在三个月、六个月和一年时进行了治疗调整,在接受联合治疗的患者中,分别有 2.74%、4.78%和 0.35%在这三个时间点进行了治疗调整。在两组中,一年后,超过 30%的患者血压得到控制(≤140/90mmHg)。一年后,患者的生理和情绪角色功能、社会功能和健康状况显著改善。
在初次诊断时,高血压的联合治疗越来越受到青睐。治疗策略的最小变化反映了推荐药物的疗效、安全性和耐受性,同时也改善了生活质量。