School of Public Health, University College Cork, Cork, Ireland.
School of Medicine, University College Cork, Cork, Ireland.
Pharmacoepidemiol Drug Saf. 2024 Nov;33(11):e70025. doi: 10.1002/pds.70025.
Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several prescribing guidelines have been created to address this, however, prescriber adherence to guidelines is influenced by various sociodemographic patient factors. This study aims to determine the effects of these patient factors on prescriber adherence to antihypertensive prescription guidelines.
A secondary analysis of data from the first wave of The Irish Longitudinal Study on Ageing (TILDA), was conducted. Participants were included if they reported previous hypertension diagnoses. Antihypertensive medication regimes were compared with the prescribing guidance in the 2011 NICE hypertension guidelines. The effects of patient sociodemographic factors on prescriber adherence to guidelines, and the effect of prescriber adherence on blood pressure control (≥ 140/90 mmHg), were determined using binomial logistic regression models.
A total of 2992 participants were included in this analysis; 54.9% female with mean age 65.7 years (±9.23). Male sex and older age, and lower socioeconomic status were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥ 55 years (Relative Risk [RR] 0.75 [0.62, 0.91]), and female patients across all age groups (RR 0.80 [0.67, 0.95]). Better blood pressure control was seen with medication regimes adherent to prescription guidelines (140.38 (±18.98)/83.09 (±11.02) mmHg adherent vs. 141.66 (±19.86)/84.77 (±11.71) mmHg non-adherent).
This study highlights the effect of patient sex on prescriber adherence to antihypertensive prescription guidelines, emphasizing a larger issue of systemic undertreatment of females observed within healthcare. Further research is needed to determine the reasons for such differences in hypertensive care.
全球范围内，不受控制的高血压会导致严重的发病率和死亡率。为此制定了几项处方指南，然而，医生对指南的遵守受到各种社会人口学患者因素的影响。本研究旨在确定这些患者因素对医生遵守抗高血压处方指南的影响。
对爱尔兰老龄化纵向研究（TILDA）第一波数据进行二次分析。如果参与者报告有先前的高血压诊断，则将其纳入研究。将抗高血压药物治疗方案与 2011 年 NICE 高血压指南中的处方指南进行比较。使用二项逻辑回归模型确定患者社会人口学因素对医生遵守指南的影响，以及医生遵守指南对血压控制（≥140/90mmHg）的影响。
本分析共纳入 2992 名参与者；女性占 54.9%，平均年龄为 65.7±9.23 岁。男性、年龄较大和较低的社会经济地位与增加医生遵守指南的可能性相关。在≥55 岁的女性患者（相对风险 [RR] 0.75[0.62，0.91]）和所有年龄段的女性患者（RR 0.80[0.67，0.95]）中，医生更不可能遵守指南。药物治疗方案符合处方指南时，血压控制更好（遵医嘱组收缩压为 140.38±18.98mmHg，舒张压为 83.09±11.02mmHg；不遵医嘱组收缩压为 141.66±19.86mmHg，舒张压为 84.77±11.71mmHg）。
本研究强调了患者性别对医生遵守抗高血压处方指南的影响，突出了在医疗保健中观察到的女性系统性治疗不足这一更大问题。需要进一步研究以确定高血压治疗中存在此类差异的原因。
