西南地区住院高血压患者临床特征、治疗与控制状况及其影响因素
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摘要
目的了解西南地区中心城市三甲医院心内科住院高血压患者临床特征、降压治疗状况、高血压控制率及其影响因素。方法选取成都、贵阳、重庆、昆明的5家三级甲等医院为合作研究中心,于2011年8月～2012年2月在各医院心内科抽取符合纳入标准的住院患者为研究对象。收集研究对象的一般人口学资料,调查患者的心血管危险因素、靶器官损害及相关疾病情况、降压药物应用情况、血压控制状况,分析影响血压控制的因素。结果 40岁以上住院高血压患者共计2031例,平均年龄(59.4±10.3)岁。2级和3级高血压分别占42.1%、48.8%,主要心血管危险因素高脂血症、糖尿病、吸烟、肥胖的患病率均较高,除血压及年龄因素外,80%的患者至少有一个主要的心血管危险因素。高血压患者合并靶器官损害及相关疾病较为普遍。72.6%的2、3级高血压患者予以两种或两种以上降压药物治疗。降压药物使用最多的是钙通道阻滞剂(CCB)。所有联合降压方案,CCB联合血管紧张素受体阻滞剂(ARB)是最常用的降压组合。出院时高血压控制率为54.5%。影响住院期间高血压治疗达标的主要危险因素为年龄、慢性肾功能不全、糖尿病、漏服降压药、高血压分级3级及肥胖。结论西南地区三甲医院住院高血压患者合并主要心血管危险因素、靶器官损害及相关疾病均较为常见。住院高血压患者降压治疗基本规范,高血压控制率尚可。合理控制高血糖,适宜控制体重,改善肾功能不全患者肾功水平,提高服药依从性,对于提高住院高血压患者降压达标率可能有积极意义。
Objective To survey the clinical features, status of antihypertensive treatment, and control of hypertension among hypertensive patients treated in department of cardiology of tertiary hospitals in central cities in Southwest China. Methods Five tertiary hospitals, two in Chengdu, and one each in Guiyang, Chongqing, and Kunming, were selected as the centers of study. Inpatients in department of cardiology from August 2011 to February 2012 who met the inclusion criteria were included in this study. Information regarding general demographics, cardiovascular disease(CVD) risk factors, target organ damage or associated diseases among hypertensive patients, antihypertensive treatment, and control rate of hypertension were collected and analyzed factors. Results The study consisted of 2,031 hypertensive inpatients aged 40 years and older [average(59.4 ± 10.3)years]. In the study, 42.1% of patients had stage 2 hypertension, and 48.8% had stage 3 hypertension. The prevalence of major CVD risk factors, including hyperlipidemia, diabetes, smoking, and obesity, was relatively high. Other than hypertension and old age,80% of patients had at least one major CVD risk factor. Target organ damage and associated diseases were common among the hypertensive patients. In total, 72.6% of the stage 2 and 3 hypertensive patients were treated with two or more antihypertensive drugs. Calcium channel blockers(CCB)were the most commonly used antihypertensive drug. CCB and angiotensin II receptor blockers(ARBs) were the most common type of combination antihypertensive therapy. The control of hypertension was 54.5% at the time of patient discharge. Major risk factors that affected BP control rates during hospitalization included age, chronic renal insufficiency, diabetes, missing antihypertensive drugs, stage 3 hypertension, and obesity. Conclusion In summary,most of the hypertensive inpatients had moderate to severe hypertension, which was commonly accompanied by major CVD risk factors, as well as target organ damage and associated diseases. Although the antihypertensive treatment of hypertensive inpatients was standardized, with acceptable BP control rates, there is room for improvements. Improvements in hyperglycemia control, weight control, and drug compliance, as well as improvements in the renal functions of patients with renal insufficiency, perhaps could markedly enhance BP control rate of hypertensive inpatients.
Objective To survey the clinical features, status of antihypertensive treatment, and control of hypertension among hypertensive patients treated in department of cardiology of tertiary hospitals in central cities in Southwest China. Methods Five tertiary hospitals, two in Chengdu, and one each in Guiyang, Chongqing, and Kunming, were selected as the centers of study. Inpatients in department of cardiology from August 2011 to February 2012 who met the inclusion criteria were included in this study. Information regarding general demographics, cardiovascular disease(CVD) risk factors, target organ damage or associated diseases among hypertensive patients, antihypertensive treatment, and control rate of hypertension were collected and analyzed factors. Results The study consisted of 2,031 hypertensive inpatients aged 40 years and older [average(59.4 ± 10.3)years]. In the study, 42.1% of patients had stage 2 hypertension, and 48.8% had stage 3 hypertension. The prevalence of major CVD risk factors, including hyperlipidemia, diabetes, smoking, and obesity, was relatively high. Other than hypertension and old age,80% of patients had at least one major CVD risk factor. Target organ damage and associated diseases were common among the hypertensive patients. In total, 72.6% of the stage 2 and 3 hypertensive patients were treated with two or more antihypertensive drugs. Calcium channel blockers(CCB)were the most commonly used antihypertensive drug. CCB and angiotensin II receptor blockers(ARBs) were the most common type of combination antihypertensive therapy. The control of hypertension was 54.5% at the time of patient discharge. Major risk factors that affected BP control rates during hospitalization included age, chronic renal insufficiency, diabetes, missing antihypertensive drugs, stage 3 hypertension, and obesity. Conclusion In summary,most of the hypertensive inpatients had moderate to severe hypertension, which was commonly accompanied by major CVD risk factors, as well as target organ damage and associated diseases. Although the antihypertensive treatment of hypertensive inpatients was standardized, with acceptable BP control rates, there is room for improvements. Improvements in hyperglycemia control, weight control, and drug compliance, as well as improvements in the renal functions of patients with renal insufficiency, perhaps could markedly enhance BP control rate of hypertensive inpatients.
引文
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[11] 中国肥胖问题工作组数据汇总分析协作组. 我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J]. 中华流行病学杂志,2002,(1):10-15.
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[13] 刘力生,张维忠,郝建生,等. 非洛地平缓释片在高血压治疗中的达标率和安全性研究[J]. 中华心血管病杂志,2004,(4):7-10.
[14] Liu L, Wang JG, Gong L, et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group[J]. J Hypertens,1998,16(12 Pt 1):1823-1829.
[15] Hu D, Liu L, Li W. Efficacy and safety of valsartan/amlodipine single-pill combination in 11,422 Chinese patients with hypertension: an observational study[J]. Adv Ther,2014,31(7):762-775.
[16] Wu Y, Huxley R, Li L, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002[J]. Circulation,2008,118(25):2679-2686.
[17] Yang L, Yan J, Tang X, et al. Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013[J]. PLoS One,2016,11(1):e146181.
[18] Dong G, Sun Z, Zheng L, et al. Prevalence, awareness, treatment, and control of hypertension in rural adults from Liaoning Province, northeast China[J]. Hypertens Res,2007,30(10):951-958.
[19] Liu X, Gu W, Li Z, et al. Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update[J]. J Hypertens,2017,35(3):637-644.
[20] Yan Z, Wang Y, Li S, et al. Hypertension Control in Adults with CKD in China: Baseline Results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE)[J]. Am J Hypertens,2018.
[21] Costa FF, Timerman A, Saraiva J, et al. Independent predictors of effective blood pressure control in patients with hypertension on drug treatment in Brazil[J]. J Clin Hypertens (Greenwich),2018,20(1):125-132.
[2] James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)[J]. JAMA,2014,311(5):507-520.
[3] Gao Y, Chen G, Tian H, et al. Prevalence of hypertension in china: a cross-sectional study[J]. PLoS One,2013,8(6):e65938.
[4] Berrington DGA, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults[J]. N Engl J Med,2010,363(23):2211-2219.
[5] Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies[J]. Lancet,2009,373(9669):1083-1096.
[6] Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies[J]. Lancet,2002,360(9349):1903-1913.
[7] 胡大一,刘力生,余金明,等. 中国门诊高血压患者治疗现状登记研究[J]. 中华高血压杂志,2010,(6):600.
[8] 刘力生. 中国高血压防治指南2010[J]. 中华高血压杂志,2011,(8):701-743.
[9] 中国2型糖尿病防治指南(2013年版)[J]. 中国糖尿病杂志,2014,(8):2-42.
[10] 诸骏仁,高润霖,赵水平,等. 中国成人血脂异常防治指南(2016年修订版)[J]. 中国循环杂志,2016,(10):937-953.
[11] 中国肥胖问题工作组数据汇总分析协作组. 我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J]. 中华流行病学杂志,2002,(1):10-15.
[12] 李社昌. 中国三甲医院门诊高血压患者控制率、依从性及其影响因素分析[D]. 复旦大学,2012.
[13] 刘力生,张维忠,郝建生,等. 非洛地平缓释片在高血压治疗中的达标率和安全性研究[J]. 中华心血管病杂志,2004,(4):7-10.
[14] Liu L, Wang JG, Gong L, et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group[J]. J Hypertens,1998,16(12 Pt 1):1823-1829.
[15] Hu D, Liu L, Li W. Efficacy and safety of valsartan/amlodipine single-pill combination in 11,422 Chinese patients with hypertension: an observational study[J]. Adv Ther,2014,31(7):762-775.
[16] Wu Y, Huxley R, Li L, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002[J]. Circulation,2008,118(25):2679-2686.
[17] Yang L, Yan J, Tang X, et al. Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013[J]. PLoS One,2016,11(1):e146181.
[18] Dong G, Sun Z, Zheng L, et al. Prevalence, awareness, treatment, and control of hypertension in rural adults from Liaoning Province, northeast China[J]. Hypertens Res,2007,30(10):951-958.
[19] Liu X, Gu W, Li Z, et al. Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update[J]. J Hypertens,2017,35(3):637-644.
[20] Yan Z, Wang Y, Li S, et al. Hypertension Control in Adults with CKD in China: Baseline Results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE)[J]. Am J Hypertens,2018.
[21] Costa FF, Timerman A, Saraiva J, et al. Independent predictors of effective blood pressure control in patients with hypertension on drug treatment in Brazil[J]. J Clin Hypertens (Greenwich),2018,20(1):125-132.