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Combination Antihypertensive Therapy Prescribing and Blood Pressure Control in a Real-World Setting.

真实环境中的联合降压治疗处方和血压控制。

  • 影响因子:2.49
  • DOI:10.1093/ajh/hpz196
  • 作者列表:"Magvanjav O","Cooper-Dehoff RM","McDonough CW","Gong Y","Hogan WR","Johnson JA
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Specific combinations of two drug classes are recommended in a variety of clinical situations in the management of hypertension. These preferred combinations are based on complimentary blood pressure (BP) lowering mechanisms or benefit for a concomitant disease. METHODS:Using electronic health records (EHRs) data from 27,579 ambulatory hypertensive patients, we investigated antihypertensive therapy prescribing patterns and associations of preferred two drug classes with BP control. RESULTS:Overall, BP control, defined as BP <140/90 mm Hg, was 65% among treated patients. Preferred dual antihypertensive therapy was prescribed in 55% of patients with uncomplicated hypertension, 49% of patients with diabetes, and 47% of patients with a history of myocardial infarction (MI); these prescribing frequencies of preferred combinations were not explained by worse BP control on those combinations. In fact, we found suggestive evidence of association between prescribing of preferred two drug classes and improved BP control among post-MI (OR: 1.21, 95% CI: 0.99-1.48, P = 0.061) and uncomplicated hypertensive (OR: 1.11, 95% CI: 0.98-1.26, P = 0.089) patients. CONCLUSIONS:Prescribing of guideline-recommended antihypertensive drug classes for concomitant diseases is suboptimal and prescribing of preferred/optimized drug class combinations was moderate. We did not find a clear association between the use of optimized drug class combinations and greater BP control. Overall, using EHR data, we identified potential opportunities for re-examining prescribing practices with implications for clinical decision support and healthcare improvement at the community and health system-wide levels.

摘要

背景: 在高血压管理的各种临床情况下,推荐两种药物的特定组合。这些优选的组合是基于免费的血压 (BP) 降低机制或对伴随疾病的益处。 方法: 使用 27,579 例非卧床高血压患者的电子健康档案 (EHRs) 数据,我们调查了降压治疗处方模式和优选两种药物类别与血压控制的相关性。 结果: 总体而言,在接受治疗的患者中,血压控制 (定义为 BP <140/90mm Hg) 为 65%。55% 的无并发症高血压患者、 49% 的糖尿病患者和 47% 的有心肌梗死 (MI) 病史的患者接受了优选的双重降压治疗; 这些优选组合的处方频率不能用那些组合上更差的 BP 对照来解释。事实上,我们发现了首选两种药物处方与改善 MI 后血压控制之间关联的提示性证据 (OR: 1.21,95% CI: 0.99-1.48,P = 0.061) 和无并发症的高血压 (OR: 1.11,95% CI: 0.98-1.26,P = 0.089) 患者。 结论: 指南推荐的抗高血压药物类别对伴随疾病的处方不理想,优选/优化药物类别组合的处方中等。我们没有发现使用优化的药物类别组合与更大的 BP 控制之间存在明确的关联。总体而言,使用 EHR 数据,我们确定了重新检查处方实践的潜在机会,对社区和卫生系统层面的临床决策支持和医疗保健改善具有影响。

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METHODS:BACKGROUND:'Neuronal precursor cell expressed developmentally down-regulated 4-like' (NEDD4L) is considered a candidate gene for hypertension-both functionally and genetically-through the regulation of the ubiquitination of the epithelial sodium channel (ENaC). This study explores the relationship between genetic variation in NEDD4L and hypertension with chronic kidney disease (CKD) in the southeastern Han Chinese population. METHODS:We recruited 623 CKD patients and measured ambulatory blood pressure monitoring (ABPM), and the rs4149601 and rs2288774 polymorphisms in NEDD4L were genotyped using qPCR. RESULTS:For rs4149601, significant differences in genotype frequencies in an additive model (GG vs GA vs AA) were observed between normotensive patients and hypertensive patients when hypertension was classified into ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension (P = 0.038, 0.005 and 0.006, respectively). In a recessive model (GG+GA vs AA), the frequency of the AA genotype of rs4149601 in the hypertension groups were all higher than that in the normotensive groups. The genotype distribution of rs2288774 did not differ significantly between the normotensive and hypertensive patients. In both the full cohort and the propensity score matching (PSM) cohort, the AA genotype of rs4149601 (compared to the GG+GA genotype group) was independently correlated with ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension by multivariate logistic regression analysis. CONCLUSIONS:The present study indicates that the AA genotype of rs4149601 associates with hypertension in CKD. Consequently, the rs4149601 A allele might be a risk factor for hypertension with CKD.

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