Ahluwalia J S, McNagny S E, Rask K J
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
J Gen Intern Med. 1997 Jan;12(1):7-14. doi: 10.1046/j.1525-1497.1997.12107.x.
To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients.
Case-control study.
Urban, public hospital.
A consecutive sample of patients who were aware of their diagnosis of hypertension for at least 1 month and had previously filled an antihypertensive prescription. Control patients had a systolic blood pressure (SBP) < or = 140 mm Hg and diastolic blood pressure (DBP) < or = 90 mm Hg, and case patients had a SBP > or = 180 mm Hg or DBP > or = 110 mm Hg.
Control subjects had a mean blood pressure (BP) of 130/80 mm Hg and case subjects had a mean BP of 193/106 mm Hg. Baseline demographic characteristics between the 88 case and the 133 control subjects were not significantly different. In a logistic regression model, after adjusting for age, gender, race, education, owning a telephone, and family income, controlled hypertension was associated with having a regular source of care (odds ratio [OR] 7.93; 95% confidence interval [CI] 3.86, 16.29), having been to a doctor in the previous 6 months (OR 4.81; 1.14, 20.31), reporting that cost was not a deterrent to buying their antihypertensive medication (OR 3.63; 1.59, 8.28), and having insurance (OR 2.15; 1.02, 4.52). Being compliant with antihypertensive medication regimens was of borderline significance (OR 1.96; 0.99, 3.88). A secondary analysis found that patients with Medicaid coverage were significantly less likely than the uninsured to report cost as a barrier to purchasing antihypertensive medications and seeing a physician.
The absence of out-of-pocket expenditures under Medicaid for medications and physician care may contribute significantly to BP control. Improved access to a regular source of care and increased sensitivity to medication costs for all patients may lead to improved BP control in an indigent, inner-city population.
在以少数族裔为主的接受治疗的高血压患者群体中确定血压得到控制的相关因素。
病例对照研究。
城市公立医院。
连续选取的知晓自己患有高血压至少1个月且此前已开具过抗高血压处方的患者样本。对照患者的收缩压（SBP）≤140 mmHg且舒张压（DBP）≤90 mmHg，病例患者的SBP≥180 mmHg或DBP≥110 mmHg。
对照受试者的平均血压（BP）为130/80 mmHg，病例受试者的平均BP为193/106 mmHg。88例病例受试者与133例对照受试者的基线人口统计学特征无显著差异。在逻辑回归模型中，在调整年龄、性别、种族、教育程度、是否拥有电话和家庭收入后，血压得到控制与有固定的医疗保健来源（比值比[OR] 7.93；95%置信区间[CI] 3.86，16.29）、在过去六个月内看过医生（OR 4.81；1.14，20.31）、表示费用不是购买抗高血压药物的阻碍（OR 3.63；1.59，8.28）以及拥有保险（OR 2.15；1.02，4.52）相关。遵行抗高血压药物治疗方案具有临界显著性（OR 1.96；0.99，3.88）。一项二次分析发现，有医疗补助覆盖的患者比未参保患者报告费用是购买抗高血压药物和看医生障碍的可能性显著更低。
医疗补助计划下药物和医生诊疗无需自付费用可能对血压控制有显著贡献。改善所有患者获得固定医疗保健来源的机会并提高对药物费用的敏感度可能会使贫困的市中心城区人群的血压控制情况得到改善。
