Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Int J Obes (Lond). 2024 Oct;48(10):1506-1512. doi: 10.1038/s41366-024-01613-4. Epub 2024 Aug 19.
Individuals with obesity often face obesity bias, which may influence the delivery of appropriate medical care. Our aim is to evaluate the adequacy of therapeutic decisions regarding the pharmacological treatment for hypertension in patients with diabetes, both with and without obesity.
This is a multicentric cross-sectional study of patients with type 2 diabetes and arterial hypertension who received outpatient care in Southern Brazil. Participants were stratified into two groups according to their body mass index (BMI): lower weight (BMI < 25.0 kg/m2) and with obesity (BMI ≥ 30.0 kg/m2). The primary outcome evaluated was the difference in pharmacological treatment decisions for hypertension between groups, considering individualized hypertension targets from American Diabetes Association (ADA), European Society of Hypertension (ESH), and European Society of Cardiology (ESC) guidelines. Data were analyzed as a binary endpoint (failure to receive treatment intensification vs. receiving treatment intensification when necessary) and groups were compared using multivariable logistic regression.
This study included 204 participants, of which 53 were at a lower weight and 151 had obesity. Patients with obesity more frequently failed to receive appropriate treatment intensification when compared to individuals with lower weight. The differences between the study groups were observed when considering the blood pressure target of three societies: ESH (adjusted OR 2.28 [95% CI 1.12-4.63], p = 0.022), ESC (adjusted OR 2.13 [95% CI 1.05-4.31], p = 0.035), and ADA (adjusted OR 2.33 [95% CI 1.13-4.77], p = 0.021).
These findings suggest that patients with obesity may face potential disparities in hypertension management, and obesity status may be related to therapeutic inertia in the management of arterial hypertension in this group.
肥胖个体常面临肥胖偏见，这可能影响适当医疗照护的提供。我们旨在评估在患有糖尿病的患者中，针对高血压的药物治疗决策是否充分，这些患者既有无肥胖症。
这是一项在巴西南部接受门诊治疗的 2 型糖尿病合并动脉高血压患者的多中心横断面研究。根据体重指数（BMI）将参与者分为两组：低体重（BMI<25.0kg/m2）和肥胖（BMI≥30.0kg/m2）。主要结局评估是两组之间高血压药物治疗决策的差异，考虑到美国糖尿病协会（ADA）、欧洲高血压学会（ESH）和欧洲心脏病学会（ESC）指南中针对个体的高血压目标。数据被分析为二分类结局（未能接受治疗强化与必要时接受治疗强化），并使用多变量逻辑回归比较组间差异。
这项研究纳入了 204 名参与者，其中 53 名体重较低，151 名肥胖。与体重较低的个体相比，肥胖患者更常未能接受适当的治疗强化。当考虑三个学会的血压目标时，研究组之间存在差异：ESH（调整后的 OR 2.28[95%CI 1.12-4.63]，p=0.022）、ESC（调整后的 OR 2.13[95%CI 1.05-4.31]，p=0.035）和 ADA（调整后的 OR 2.33[95%CI 1.13-4.77]，p=0.021）。
这些发现表明肥胖患者可能在高血压管理方面面临潜在的差异，并且肥胖状况可能与该组中动脉高血压治疗的治疗惰性有关。
