美国超过半数成人高血压患者血压控制不良

根据美国疾病预防控制中心(CDC)的观点，美国成人高血压患者中超过一半未能良好控制血压，甚至包括很多接受降压治疗的患者。


 
CDC主管Thomas R. Frieden博士表示，要将未控制的高血压作为“公共卫生的第二号敌人”(与之相关的每年可预防死亡人数仅次于烟草)，估计在美国有6690万成人高血压患者，高血压定义为平均收缩压≥140 mmHg，平均舒张压≥90 mmHg。根据美国卫生与营养评估调查2003~2010年的数据分析，大约3,580万患者存在血压控制不理想的情况。并且，估计有1,410万成人高血压患者并未意识到自身患有高血压，约1600万知晓自身患有高血压并接受降压治疗，另外570万患者知晓自身患有高血压但未接受治疗。

Frieden博士在一场媒体远程会议上指出，“我们正在讨论的是每年1,310亿美元的卫生支出和今年每天1,000例的死亡”，这些都是高血压未得到控制导致的，高血压是心脏病和卒中的重要危险因素。“这项调查中接近1/4的成人未控制高血压患者患有2期高血压(收缩压≥160 mmHg；舒张压≥100 mmHg)，使其发生心脏病和卒中的风险增高。”根据9月4日病死率每周报告中的数据分析，多数未控制的高血压患者有条件接收日常卫生保健(89%)、在之前1年内接受医疗保健服务(88%)和有医疗保险(85%)。也就是说，在之前1年内未接受医疗保健服务和无日常卫生保健来源的人群中，未控制高血压的患病率最高(分别为93%和87%)。并且，估计有1,410万医疗保险受益人患有高血压，其中一半以上(52%)血压控制不理想(MMWR 2012 Sept. 4 [61]:1-7)。
 

Thomas R. Frieden博士

“很明显，这些患者错过了很多可以将血压控制住的机会。临床医生知道该如何控制血压，有很多药物可以使血压得到良好控制。我们需要卷起袖子，在每次访视时将血压控制摆在首位，”Frieden博士说。 “我们需要整个医疗保健团队的共同努力，包括药剂师、护士、营养师、诊室工作人员，为患者提供最好的治疗支持和随访服务。”他建议使用电子医疗记录追踪预后，使处方重续流水线化，当然最重要的是，在每次访视时测定和记录血压，并了解读数。


除了通过以团队为基础的传递模式改善对高血压的认知和诊断外，临床机构中改善高血压控制的其他策略包括提高对管理指南的认识和依从性，优化抗高血压药物的治疗剂量和使用有效的联合治疗，监测患者病情进展，鼓励患者进行血压自我监测，并针对健康生活方式选择对患者进行教育和咨询。

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By: DIANA MAHONEY, Cardiology News Digital Network

More than half of American adults with hypertension in the United States do not have their blood pressure under control, including many of those being treated for the condition, according to the Centers for Disease Control and Prevention.

Referring to uncontrolled blood pressure as "public health enemy No. 2" – second only to tobacco in the number of potentially preventable deaths associated with it annually – CDC director Thomas R. Frieden said that an estimated 66.9 million American adults had hypertension, defined as an average systolic blood pressure of 140 mm Hg or higher and an average diastolic blood pressure of 90 mm Hg or higher. The condition is deemed uncontrolled in approximately 35.8 million of them. Further, while an estimated 14.1 million of these adults were not aware of their hypertension, roughly 16 million were aware and receiving treatment for it; another 5.7 million were aware, but were not being treated, according to an analysis of data from the National Health and Nutrition Examination Survey 2003-2010.

 
"We’re talking about $131 billion in health care costs annually and 1,000 deaths/day, today and every day this year" that can be attributed to uncontrolled hypertension, which is a major risk factor for heart disease and stroke, Dr. Frieden stated in a media telebriefing.

"Nearly one quarter of the adults with uncontrolled hypertension in the survey had stage 2 disease [systolic blood pressure of 160 mm Hg or higher; diastolic of 100 mm Hg or higher], putting them at increased risk for both heart disease and stroke," he said.

According to the analysis of the data, reported in the Sept. 4 Morbidity and Mortality Weekly Report, the majority of adults with uncontrolled hypertension had a usual source of health care (89%), had received medical care in the previous year (88%), and had health insurance (85%). That said, the prevalence rates of uncontrolled hypertension were highest (93% and 87%, respectively) among those who reported receiving no medical care in the previous year and those without a usual source of health care. Additionally, of an estimated 14.1 million Medicare beneficiaries with hypertension, more than half (52%) did not have their blood pressure under control (MMWR 2012 Sept. 4 [61]:1-7).

"There are obviously a lot of missed opportunities for getting blood pressure under control. We [clinicians] know what to do, there are great medications that work well when taken as prescribed. We have to roll up our sleeves and make blood pressure control a priority at every visit," Dr. Frieden said. "We have to engage the entire health care team, including pharmacists, nurses, nutritionists, office staff to optimize patient support and follow-up care." He suggested tapping into electronic health records to track outcomes, streamlining prescription refills, and, most important, measuring and recording blood pressure at every visit and being aware of the numbers.


 
"We know that as many as one-third of the patients or more with multiple high blood pressure readings are not being diagnosed or treated," he said. "We have to increase provider and patient awareness."

In addition to improving recognition and diagnosis of hypertension through the use of team-based delivery models, other strategies for improving hypertension control in the clinical setting include increasing knowledge of and adherence to management guidelines, optimizing dosing and the use of effective combinations of antihypertensive medications, monitoring patients’ progress, encouraging patient self-monitoring of blood pressure, and educating and counseling patients about healthy lifestyle choices, Dr. Frieden explained, noting that such efforts can lead to dramatic and rapid improvements at the patient level as well as substantial public health improvements.

No conflicts of interest were disclosed.