Hiura Grant T, Markossian Talar W, Probst Beatrice D, Habicht Katherine, Kramer Holly J
Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA.
J Clin Hypertens (Greenwich). 2025 Jan;27(1):e14933. doi: 10.1111/jch.14933. Epub 2024 Nov 5.
Therapeutic inertia (TI), or failure to escalate or initiate BP lowering medications when BP is uncontrolled, increases with advancing age and may in part be due to perceived fall risk. This study examined the association of a fall risk assessment, based on patient response to three questions administered by trained staff, with uncontrolled BP (≥140/90 mmHg) during a clinic visit and with TI during clinic visits with uncontrolled BP among 13 893 patients age ≥ 65 years corresponding to 41 122 primary care visits. Separate generalized linear mixed effects models were used to examine the association of fall risk (low, moderate, and high) with uncontrolled BP and with TI at a clinic visit after adjustment for demographics, comorbidities, and total number of visits. Baseline mean age was 73.0 years (standard deviation [SD] 5.6), 43.3% were men and questionnaire-assessed fall risk severity was low in 73.6%, moderate in 14.3%, and high in 12.2%. Compared to low fall risk, the adjusted odds of uncontrolled BP during a clinic visit were 0.97 (95% CI: 0.89, 1.06) and 0.90 (95% CI: 0.82, 0.98) with moderate and high fall risk, respectively. In contrast, adjusted odds of TI during a clinic visit with BP ≥ 140/90 mmHg was 1.16 (95% CI: 1.01, 1.34) and 1.30 (95% CI: 1.11, 1.52) with moderate and high fall risk, respectively, compared to low fall risk. These findings suggest that perceived fall risk severity may be one of several factors that influence hypertension management in older adults.
治疗惰性（TI），即血压未得到控制时未能加大剂量或启动降压药物治疗，其发生率随年龄增长而升高，部分原因可能是认为存在跌倒风险。本研究在13893名年龄≥65岁（对应41122次初级保健就诊）的患者中，考察了基于患者对由经过培训的工作人员提出的三个问题的回答所进行的跌倒风险评估，与就诊时血压未得到控制（≥140/90 mmHg）以及血压未得到控制的就诊期间的治疗惰性之间的关联。采用单独的广义线性混合效应模型，在对人口统计学、合并症和就诊总次数进行校正后，考察跌倒风险（低、中、高）与就诊时血压未得到控制以及治疗惰性之间的关联。基线平均年龄为73.0岁（标准差[SD]5.6），43.3%为男性，问卷评估的跌倒风险严重程度低的占73.6%，中度的占14.3%，高度的占12.2%。与跌倒风险低相比，就诊时血压未得到控制的校正比值比，中度跌倒风险时为0.97（95%CI：0.89，1.06），高度跌倒风险时为0.90（95%CI：0.82，0.98）。相比之下，与跌倒风险低相比，血压≥140/90 mmHg的就诊期间治疗惰性的校正比值比，中度跌倒风险时为1.16（95%CI：1.01，1.34），高度跌倒风险时为1.30（95%CI：1.11，1.52）。这些发现表明，感知到的跌倒风险严重程度可能是影响老年人高血压管理的若干因素之一。
