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指南建议对你有怎样的作用?患者对动脉高血压治疗方法的感知有效性。

How do the guideline recommendations work for you? Patients' perceived effectiveness of therapeutic approaches in arterial hypertension.

作者信息

Seiffert Johanna, Ortelbach Niklas, Hummel Anja, O'Malley Grace, Stamm Thomas, Haller Karl

机构信息

University Hospital Ruppin-Brandenburg, Department of Psychiatry, Psychotherapy and Psychosomatics, Campus Neuruppin, Neuruppin, Germany.

Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.

出版信息

J Hum Hypertens. 2024 Dec;38(12):821-827. doi: 10.1038/s41371-024-00951-0. Epub 2024 Sep 12.

DOI:10.1038/s41371-024-00951-0
PMID:39266686
Abstract

Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline's recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients' perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients' views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.

摘要

尽管动脉高血压是一种极易改变的风险因素,但在近一半的动脉高血压患者中,血压仍处于高血压范围内,而通过实施基于生活方式的治疗方法,发病率会显著降低。S3指南的建议与其实施情况之间存在显著差异。在这项对160名动脉高血压住院患者进行抽样的横断面研究中,我们评估了患者对治疗指南中推荐给他们的二级预防治疗方法的看法。此外,我们使用心理测量问卷来评估预防因素。我们进行了潜在类别分析,以确定患者观点中的模式,并测试了性别、年龄、受教育年限、体重指数、精神病理学和血压方面的组间差异。可以识别出两个潜在类别:第1类倾向于认为所有推荐的治疗方法都有帮助,反映的是血压略高于正常的个体;第2类倾向于认为关于减重、戒烟和戒酒的建议效果较差,包括轻度高血压患者;在社会人口学参数方面,两类之间没有统计学上的显著差异。我们进一步独立于类别检查了对治疗方法的评价,结果显示社会支持是最有效的方法。总之,持续升高的血压可能与对治疗方法的较差认知有关,而这些方法随后未得到实施。此外,以患者为中心的治疗计划和共同决策等理念似乎是治疗该人群二级预防的核心所在。

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Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.降压预防心血管疾病和死亡:系统评价和荟萃分析。
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