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PLoS Med:老年高血压患者:FDC治疗vs多丸联合治疗

2018-08-03 吴星 环球医学

2018年6月,发表在《PLoS Med》的一项由加拿大学者进行的基于人群的回顾性队列研究,考察了固定剂量联合降压治疗的依从性和临床结局。

2018年6月,发表在《PLoS Med》的一项由加拿大学者进行的基于人群的回顾性队列研究,考察了固定剂量联合降压治疗的依从性和临床结局。

背景:多数高血压患者需要多于1种药物实现血压控制。许多患者被处方开具了多丸降压药方案而非单药固定剂量联合(FDC)治疗。虽然FDC的使用可改善药物依从性,但是其对患者结局的影响未知。研究者使用链接到临床管理数据库中的数据,比较了真实世界中,FDC治疗vs多丸联合治疗的临床结局和药物依从性。

方法和结果:研究者进行了一项基于人群的回顾性队列研究,研究对象为13350名来自加拿大安大略的≥66岁的患者,随访5年。患者的入组标准为,新近初始1种血管紧张素转换酶抑制剂(ACEI)或血管紧张素II受体阻滞剂(ARB)+1种噻嗪类利尿剂。高维倾向得分匹配用于比较接受FDC vs多丸治疗的患者。首要结局为死亡或急性心肌梗死(AMI)、心衰卒中的复合。研究者进行了2项分析来检测依从性与患者结局的相关性。第一,研究者进行了治疗中分析,以确定患者在接受治疗时,组间结局是否存在差异,并当患者首次停止治疗(定义为不接受的药物处于前几天供应量的150%以内)时进行审查。第二,研究者进行了意愿治疗分析,随访了允许治疗中断的患者,以量化组间药物依从性的差异,并评估其对临床结局的影响。

正如预期,治疗中分析显示,组间首要结局无显着差异(HR,1.06;95% CI,0.86~1.31;P=0.60)。意愿治疗分析中,FDC组比多丸组药物覆盖的总随访天数比例显着更高[70%(IQR,19~98)vs 42%(IQR,11~91);P<0.01],FDC组发生首要结局的患者较少(3.4 vs 3.9例事件/100人-年;HR,0.89;95% CI,0.81~0.97;P<0.01)。本研究的主要局限性为缺乏关于死因和血压测量的数据,并且有残余混杂因素的可能。

结论:初始联合降压治疗的老年患者中,FDC治疗与显着较低的复合临床结局风险相关,这可能与更好的药物依从性相关。

原始出处:

Verma AA, et al. Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study. PLoS Med. 2018 Jun 11;15(6):e1002584. doi: 10.1371/journal.pmed.1002584. eCollection 2018 Jun.

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    2018-08-18 owlhealth

    学习了,不错耶

    0

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