强化药物治疗和提高患者依从性是控制高血压的关键

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Intensifying - and adhering to - medication key to hypertension control
强化药物治疗和提高患者依从性是控制高血压的关键 （2008－2－13）
MedWire News: Both physicians' failure to intensify antihypertensive treatment and patients' failure to adhere to their medications contribute to the difficulty in controlling hypertension, a study of coronary artery disease (CAD) patients shows.
MedWire News：一项关于心脏病患者的研究显示，医生加强抗高血压治疗的失策和患者不能坚持药物治疗是造成高血压控制困难的两大因素。
Furthermore, the research suggests that non-adherence may explain why patients often fail to get their blood pressure (BP) under control despite having antihypertensive medications intensified.
并且，该研究提示，依从性欠佳可以解释为什么尽管加强了抗高血压药物治疗，病人仍然经常不能把他们的血压控制下来。
Michael Ho (Denver Veterans Affairs Medical Center, Colorado, USA) and colleagues studied the medical records of 10,447 CAD patients enrolled on the health-care system at Kaiser Permanent of Colorado.
Michael Ho （美国科罗拉多丹佛退伍军事务医学中心）和同事们研究了登记于Kaiser Permanent of Colorado健康体检中心的10447名心脏病患者的病历。
Most patients (87.2%) had controlled BP (systolic [S]BP; ≤140 mmHg) that remained
stable over time (median follow-up, 4.5 years). Meanwhile, 7.5% of patients had high BP (SBP >140 mmHg) that became controlled over time, and just 5.3% had high BP that remained high throughout the study period.
大多数患者（87.2％）已经控制了血压（收缩压≤140 mmHg）并在研究期间间保持了稳定（持续用药4.5年）。同时，7.5％血压偏高的患者（收缩压 >140 mmHg）在随后的时间血压得到了控制，只有5.3％的患者在研究期间仍然持续血压偏高。
Patients with high BP that remained uncontrolled and those whose BP was brought under control by the end of observation were more likely to be non-adherent to medication, defined as less than 80% of days covered, than those with normal BP that remained under control. They were also more likely to have their therapy intensified, defined as a dosage increase for any drug or an increase in the total number of antihypertensive medications.
高血压持续未得到控制的患者以及那些血压最后方得到控制的患者看起来很大程度上服药依从性较差，具体讲，相比于那些血压得到控制，血压正常的患者，他们的用药时间少于研究期间的80％。他们还更倾向于加强他们的药物治疗，具体讲就是增加某些药物剂量，或增加降压药的药品总数量。
As reported in the Archives of Internal Medicine, multivariable analysis indicated hat patients with persistently uncontrolled BP were more likely to be nonadherent to medication (odds ratio [OR]=1.73) and to have had their therapy intensified (OR=1.31) relative to those with high BP that was brought under control over time.
《内科文件》中报道，多元分析提示：血压持续未得到控制的患者更多的存在不持续服药( OR=1.73)，并且加强药物治疗（OR=1.31)与那些血压在研究过程中得到控制的高血压患者相关。
Similarly, patients with persistently uncontrolled BP were more likely to be nonadherent to medications (OR=1.50) and to have had therapy intensified （OR=2.86) than those with normal BP that remained controlled.
简单地说，持续高血压患者多数药物依从性差 (OR=1.50) ，并且比血压控制正常的患者更多地采取强化治疗的手段。
The authors say these findings \"suggest that medication nonadherence may explain why BP levels remained elevated despite intensification of treatment with antihypertensive medications.\"
作者认为这些发现“提示药物依从性差可以解释，尽管强化了降压药治疗，血压水平却仍然持续升高”
In contrast, patients with high BP that was brought under control were more likely to have therapy intensified (OR=2.21) but no more likely to be nonadherent to medications than those with normal BP that remained controlled. This suggests that having therapy intensified and taking the medications as prescribed resulted in these patients' decreases in BP levels over time, the authors note.
相反地，血压得到控制的高血压患者尽管也采取强化治疗(OR=2.21)，但在依从性方面，他们和血压正常患者人群类似。作者认为，这提示了强化治疗和规范化治疗导致这些患者血压下降。
They conclude: \"Successful blood pressure control is seen with a combination of intensification and adherence, suggesting that therapy intensification must be coupled with interventions to enhance medication adherence.\"
他们得出结论：成功的控制血压看起来要同时做到强化治疗和提高依从性相结合。他们建议强化治疗必须同时做到强化患者依从性。
Arch Intern Med 2008; 168: 271-276