Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Área departamental de Medicina, Facultad de Ciencias de la Salud, Universidad Católica de Ávila Santa Teresa de Jesús, Ávila, Spain.
Rev Esp Cardiol (Engl Ed). 2024 Sep;77(9):767-778. doi: 10.1016/j.rec.2024.03.011. Epub 2024 May 1.
In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: a) white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); b) inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and c) insufficient use of polytherapy (≈55%). The remaining challenges include: a) technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); b) clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and c) public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets.
在西班牙，2019 年 30 至 79 岁的成年人中有 33%（1000 万人）患有高血压。其中，68%被诊断出患有高血压，57%接受了药物治疗，有效的治疗覆盖率（控制率）达到 33%。诊断和控制情况均存在地域和社会差异。每年约有 46000 人死于高血压。近几十年来，由于生活方式改善和多药物治疗的增加，同时伴随着中风死亡率的降低，高血压的控制情况有所改善。导致高血压控制不佳的可修正决定因素有以下几点：a）白大衣效应影响了 22%至 33%的治疗个体，部分原因是动态血压监测（ABPM）（49%）和自我血压监测（SMBP）（78%）的应用有限；b）患者对药物和健康生活方式的依从性不足（减肥是最有效的措施，但使用率最低，约为 40%）；c）多药物治疗的使用率不足（约为 55%）。其余挑战包括：a）技术方面，例如使用更准确的技术（ABPM、SMBP）测量血压和使用心血管风险评估工具（如 SCORE）；b）临床挑战，如减少治疗惰性（约 59%），让患者参与自身管理（药物依从性，约 62%），并有效实施临床指南）；c）公共卫生挑战，如减轻肥胖负担（约 24%），通过更新的调查监测进展，并制定国家血压控制目标。
