Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
Hypertens Res. 2024 Mar;47(3):598-607. doi: 10.1038/s41440-023-01452-2. Epub 2023 Oct 23.
We aimed to quantify the impact of inadequate pharmacological therapy on uncontrolled blood pressure (BP) using Japanese real-world data. This retrospective cohort study used databases provided by DeSC Healthcare, Inc (Tokyo, Japan). We identified 27,652 patients with hypertension (age, 60.7 ± 9.1 years; men, 56.4%) who were not receiving antihypertensive treatment at the initial visit (pre-treatment) and were under treatment at the next visit (post-treatment). Patients were classified into the following groups by the number of antihypertensive drug classes and defined daily dose (DDD): one antihypertensive drug class with a low dose (DDD < 1.0), one antihypertensive drug class with a moderate-to-high dose (DDD ≥ 1.0), two antihypertensive drug classes with a low dose (DDD < 2.0), two antihypertensive drug classes with a moderate-to-high dose (DDD ≥ 2.0), and ≥three antihypertensive drug classes. The pre-treatment systolic/diastolic BP was 157.7 ± 15.4/94.2 ± 11.5 mmHg. Overall, 43.0% of patients had uncontrolled BP (post-treatment BP ≥ 140/ ≥ 90 mmHg). High pre-treatment BP was a strong factor for uncontrolled BP. After adjustments for covariates, including the pre-treatment mean BP, the proportion of patients with uncontrolled BP was 2.08 times higher in the one antihypertensive drug class with a low dose group than in the ≥three antihypertensive drug classes group. The preventable fraction due to <three antihypertensive drug classes for uncontrolled BP was 40.6%. Only 9.9% of patients with the pre-treatment BP ≥ 180/ ≥ 110 mmHg were prescribed ≥ three antihypertensive drug classes. High pre-treatment BP and inadequate antihypertensive treatment were major factors contributing to uncontrolled BP. Adequate treatment intensification would resolve approximately 40% of uncontrolled BP cases among Japanese patients treated for hypertension.
我们旨在使用日本真实世界数据来量化药物治疗不足对血压控制不良的影响。这项回顾性队列研究使用了来自 DeSC Healthcare, Inc（日本东京）提供的数据库。我们共纳入 27652 例高血压患者（年龄 60.7±9.1 岁，男性占 56.4%），这些患者在初诊时（治疗前）未接受降压治疗，在下一次就诊时（治疗后）正在接受治疗。根据抗高血压药物种类和定义日剂量（DDD）的数量，将患者分为以下几组：一种低剂量（DDD<1.0）抗高血压药物类别、一种中高剂量（DDD≥1.0）抗高血压药物类别、两种低剂量（DDD<2.0）抗高血压药物类别、两种中高剂量（DDD≥2.0）抗高血压药物类别和≥三种抗高血压药物类别。治疗前收缩压/舒张压为 157.7±15.4/94.2±11.5mmHg。总体而言，43.0%的患者血压控制不良（治疗后血压≥140/≥90mmHg）。高治疗前血压是血压控制不良的一个重要因素。在调整了包括治疗前平均血压在内的混杂因素后，与≥三种抗高血压药物类别组相比，低剂量单药治疗组血压控制不良的患者比例高出 2.08 倍。因未使用<三种抗高血压药物类别而导致的不可控血压的可预防比例为 40.6%。仅 9.9%的治疗前血压≥180/≥110mmHg的患者处方了≥三种抗高血压药物类别。高治疗前血压和抗高血压治疗不足是导致血压控制不良的主要因素。适当的治疗强化可以解决日本高血压患者中约 40%的血压控制不良病例。
