Flack J M, Novikov S V, Ferrario C M
Wake Forest University, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1032, USA.
Eur Heart J. 1996 Mar;17 Suppl A:16-20. doi: 10.1093/eurheartj/17.suppl_a.16.
Long-term adherence or compliance with anti-hypertensive drug therapy is poor. It has been estimated that within the first year of treatment 16-50% of hypertensives discontinue their anti-hypertensive medications. Even among those who remain on therapy long term, missed medication doses are common. Epidemiological studies have shown that drug-treated hypertensives have higher blood pressures than age-, gender- and body mass index-matched normotensives. In addition, drug-treated hypertensive men and women who achieve blood pressure normalization are less likely to die over a 9.5-year period than those whose blood pressure remains elevated while taking anti-hypertensive drugs. Thus, one reason for less than optimal reduction of blood pressure-related cardiovascular-renal risk in drug-treated hypertensives is inadequate blood pressure lowering. Quantifiable excess risk has been documented even in the short term ( < 1 year) after interruption or discontinuation of anti-hypertensive medications as total healthcare costs are higher, mostly because of higher hospitalization rates. Data from the Treatment of Mild Hypertension Study (TOMHS) are relevant to long-term adherence to various anti-hypertensive drug monotherapies. At 48 months, 82.5% and 77.8% of participants remained on amlodipine and acebutolol, respectively (both P < 0.01 compared with placebo). However, only 67.5%, 66.1% and 68.1%, respectively, of chlorthalidone, doxazosin and enalapril participants remained on these drugs as monotherapy at 48 months. Differential adherence to long-term anti-hypertensive drug therapy could translate into a greater risk of blood pressure-related complications and higher overall healthcare expenditures. Strategies to minimize the deleterious impact of therapeutic non-adherence with anti-hypertensive medications as well as the clinical and cost implications of the TOMHS data will be discussed.
长期坚持或依从抗高血压药物治疗的情况较差。据估计，在治疗的第一年，16%至50%的高血压患者会停用抗高血压药物。即使在那些长期接受治疗的患者中，漏服药物剂量的情况也很常见。流行病学研究表明，接受药物治疗的高血压患者的血压高于年龄、性别和体重指数相匹配的血压正常者。此外，血压恢复正常的接受药物治疗的高血压男性和女性在9.5年期间死亡的可能性低于那些在服用抗高血压药物时血压仍居高不下的患者。因此，在接受药物治疗的高血压患者中，血压相关的心血管-肾脏风险降低未达最佳水平的一个原因是血压降低不充分。即使在停用抗高血压药物后的短期内（<1年），也有可量化的额外风险记录，因为总医疗费用更高，主要是由于住院率较高。轻度高血压治疗研究（TOMHS）的数据与长期坚持各种抗高血压药物单一疗法相关。在48个月时，分别有82.5%和77.8%的参与者仍在服用氨氯地平和醋丁洛尔（与安慰剂相比，两者P<0.01）。然而，在48个月时，分别只有67.5%、66.1%和68.1%的服用氯噻酮、多沙唑嗪和依那普利的参与者仍在接受这些药物单一疗法治疗。长期抗高血压药物治疗的依从性差异可能转化为血压相关并发症的更大风险和更高的总体医疗支出。将讨论尽量减少抗高血压药物治疗不依从的有害影响以及TOMHS数据的临床和成本影响的策略。
