Joshi P P, Salkar R G, Heller R F
Clinical Epidemiology Unit, Government Medical College, Nagpur, India.
J Hum Hypertens. 1996 May;10(5):299-303.
To determine the factors responsible for poor blood pressure (BP) control among patients started on treatment for hypertension, with the hypothesis that patient non-compliance would be an important determinant.
Patients attending the Cardiology Clinic of the Government Medical College, Nagpur with hypertension for the first time were followed for 3 months and labelled as uncontrolled, if at end of this time the mean of two measures of diastolic blood pressure (DBP) was > 95 mm Hg, despite apparently adequate anti-hypertensive drugs.
Compliance (measured by pill count), life stress (measured by life event score), smoking and alcohol intake and demographic variables (measured by an interviewer-administered questionnaire), and body mass index (BMI).
Of 156 subjects recruited, 139 (89%) completed follow-up of 3 months, of whom 45 (32%) had uncontrolled hypertension (DBP > 95 mm Hg) at the end of follow-up. There was no statistically significant difference in the baseline characteristics of subjects who completed follow-up as compared with those lost to follow-up. The mean age of the patients was 55 years and male to female ratio was 1.5:1. Sixty-one per cent of the uncontrolled hypertensives were non-compliant by pill count (taking < 80% of drugs) as compared to 21% of the controlled hypertensives (odds ratio, OR = 6.1, 95% Cl = 3.9-12.6; P < 0.0001). There was no statistically significant difference in the mean age, mean BMI, sex distribution, alcohol intake, cigarette smoking rates, educational level, occupational or marital status between controlled and uncontrolled hypertensives. The median life event score (LES) was significantly higher in uncontrolled than in controlled hypertensives 4 vs 1.5 (P < 0.00001). Multiple logistic regression analysis found non-compliance and LES to be statistically significant independent predictors of uncontrolled hypertension.
Patient non-compliance with drugs and life stress may help explain poor BP control in patients on treatment for hypertension in this setting.
确定接受高血压治疗的患者血压控制不佳的相关因素，假设患者不依从是一个重要的决定因素。
首次到那格浦尔政府医学院心脏病科就诊的高血压患者被随访3个月，如果在这段时间结束时，尽管使用了明显足够的抗高血压药物，但两次舒张压（DBP）测量的平均值>95mmHg，则被标记为血压未得到控制。
依从性（通过药丸计数测量）、生活压力（通过生活事件评分测量）、吸烟和饮酒情况以及人口统计学变量（通过访谈者 administered 问卷测量）和体重指数（BMI）。
在招募的156名受试者中，139名（89%）完成了3个月的随访，其中45名（32%）在随访结束时患有未控制的高血压（DBP>95mmHg）。完成随访的受试者与失访受试者的基线特征在统计学上没有显著差异。患者的平均年龄为55岁，男女比例为1.5:1。与21%血压得到控制的高血压患者相比，61%血压未得到控制的高血压患者药丸计数不依从（服用<80%的药物）（优势比，OR=6.1，95%CI=3.9-12.6；P<0.0001）。血压得到控制和未得到控制的高血压患者在平均年龄、平均BMI、性别分布、饮酒情况、吸烟率、教育水平、职业或婚姻状况方面没有统计学上的显著差异。未控制的高血压患者的中位生活事件评分（LES）显著高于血压得到控制的高血压患者，分别为4和1.5（P<0.00001）。多因素逻辑回归分析发现，不依从和LES是未控制高血压的统计学显著独立预测因素。
在这种情况下，患者不依从药物治疗和生活压力可能有助于解释高血压治疗患者血压控制不佳的原因。
