中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
33期
2709-2714
,共6页
梁东亮%李小鹰%王林%徐浩%拓西平%蹇在金
樑東亮%李小鷹%王林%徐浩%拓西平%蹇在金
량동량%리소응%왕림%서호%탁서평%건재금
冠状动脉疾病%老年患者%高血压%糖尿病%达标率
冠狀動脈疾病%老年患者%高血壓%糖尿病%達標率
관상동맥질병%노년환자%고혈압%당뇨병%체표솔
Coronary heart disease%Aged patient%Hypertention%Diabetes mellitus%Control rate
目的 了解老年冠心病合并糖尿病及高血压患者降压达标和降压药物使用现状.方法 2011年4-7月对全国21个省市165家医院门诊的老年冠心病患者(≥60岁)进行多中心、非干预性、横断面的临床流行病学调查,本研究对纳入研究的患者不同降压目标值的降压达标率、降压用药方式以及指南推荐的规范用药等进行现况调查.结果 纳入研究的7 962例患者中,共筛选出1 379例高血压合并糖尿病有效患者,占17.3％;(1)降压目标值＜130/80 mmHg(1 mmHg=0.133 kPa),达标率为17.1％;血压＜140/80 mmHg,达标率为27.5％;血压＜140/90 mmHg,达标率为39.6％;血压＜ 150/90 mmHg,达标率为51.7％;年龄≥70岁的患者中不同目标降压达标率都随年龄的增加而逐渐增高,年龄＞85岁的患者的降压达标率为最高,71 ～75岁年龄段最低;男女患者的不同目标降压达标率相接近,男性稍高于女性;(2)1 379例患者中,明确是否接受降压治疗1 347例,缺失32例;接受降压治疗的患者1 317例,治疗率为97.8％(1 317/1 347),降压药物使用最多的是血管紧张素受体拮抗剂(A RB)或血管紧张素转换酶抑制剂(ACEI)(使用率76.8％),其次为二氢吡啶类钙离子拮抗剂(CCB)(65.5％)、β-受体阻滞剂(44.6％)、噻嗪类利尿剂(26.3％);(3)使用二联降压的方式最常见,占41.2％,其次为三联及以上用药降压占34.9％、单药降压占23.9％;单药降压方式最常见是CCB(占8.8％);双联降压方式最常见的组合是CCB+ ARB类(占11.7％);三联及以上降压方式最常见的组合是CCB+ARB类+β-受体阻滞剂(9.2％);(4)指南推荐的规范用药人数987例,占76.6％;二联降压方式中规范联合用药的比例为71.9％;三联及以上降压方式中规范联合用药的比例为66.1％.结论 老年冠心病合并糖尿病高血压患者接受降压的治疗率较高,但其血压达标率偏低,主要的降压药物以ARB/ACEI类为主,CCB其次,利尿剂使用偏少,主要的药物治疗方式以联合降压为主,遵循指南治疗建议的意识有所提高,但仍需加强.
目的 瞭解老年冠心病閤併糖尿病及高血壓患者降壓達標和降壓藥物使用現狀.方法 2011年4-7月對全國21箇省市165傢醫院門診的老年冠心病患者(≥60歲)進行多中心、非榦預性、橫斷麵的臨床流行病學調查,本研究對納入研究的患者不同降壓目標值的降壓達標率、降壓用藥方式以及指南推薦的規範用藥等進行現況調查.結果 納入研究的7 962例患者中,共篩選齣1 379例高血壓閤併糖尿病有效患者,佔17.3％;(1)降壓目標值＜130/80 mmHg(1 mmHg=0.133 kPa),達標率為17.1％;血壓＜140/80 mmHg,達標率為27.5％;血壓＜140/90 mmHg,達標率為39.6％;血壓＜ 150/90 mmHg,達標率為51.7％;年齡≥70歲的患者中不同目標降壓達標率都隨年齡的增加而逐漸增高,年齡＞85歲的患者的降壓達標率為最高,71 ～75歲年齡段最低;男女患者的不同目標降壓達標率相接近,男性稍高于女性;(2)1 379例患者中,明確是否接受降壓治療1 347例,缺失32例;接受降壓治療的患者1 317例,治療率為97.8％(1 317/1 347),降壓藥物使用最多的是血管緊張素受體拮抗劑(A RB)或血管緊張素轉換酶抑製劑(ACEI)(使用率76.8％),其次為二氫吡啶類鈣離子拮抗劑(CCB)(65.5％)、β-受體阻滯劑(44.6％)、噻嗪類利尿劑(26.3％);(3)使用二聯降壓的方式最常見,佔41.2％,其次為三聯及以上用藥降壓佔34.9％、單藥降壓佔23.9％;單藥降壓方式最常見是CCB(佔8.8％);雙聯降壓方式最常見的組閤是CCB+ ARB類(佔11.7％);三聯及以上降壓方式最常見的組閤是CCB+ARB類+β-受體阻滯劑(9.2％);(4)指南推薦的規範用藥人數987例,佔76.6％;二聯降壓方式中規範聯閤用藥的比例為71.9％;三聯及以上降壓方式中規範聯閤用藥的比例為66.1％.結論 老年冠心病閤併糖尿病高血壓患者接受降壓的治療率較高,但其血壓達標率偏低,主要的降壓藥物以ARB/ACEI類為主,CCB其次,利尿劑使用偏少,主要的藥物治療方式以聯閤降壓為主,遵循指南治療建議的意識有所提高,但仍需加彊.
목적 료해노년관심병합병당뇨병급고혈압환자강압체표화강압약물사용현상.방법 2011년4-7월대전국21개성시165가의원문진적노년관심병환자(≥60세)진행다중심、비간예성、횡단면적림상류행병학조사,본연구대납입연구적환자불동강압목표치적강압체표솔、강압용약방식이급지남추천적규범용약등진행현황조사.결과 납입연구적7 962례환자중,공사선출1 379례고혈압합병당뇨병유효환자,점17.3％;(1)강압목표치＜130/80 mmHg(1 mmHg=0.133 kPa),체표솔위17.1％;혈압＜140/80 mmHg,체표솔위27.5％;혈압＜140/90 mmHg,체표솔위39.6％;혈압＜ 150/90 mmHg,체표솔위51.7％;년령≥70세적환자중불동목표강압체표솔도수년령적증가이축점증고,년령＞85세적환자적강압체표솔위최고,71 ～75세년령단최저;남녀환자적불동목표강압체표솔상접근,남성초고우녀성;(2)1 379례환자중,명학시부접수강압치료1 347례,결실32례;접수강압치료적환자1 317례,치료솔위97.8％(1 317/1 347),강압약물사용최다적시혈관긴장소수체길항제(A RB)혹혈관긴장소전환매억제제(ACEI)(사용솔76.8％),기차위이경필정류개리자길항제(CCB)(65.5％)、β-수체조체제(44.6％)、새진류이뇨제(26.3％);(3)사용이련강압적방식최상견,점41.2％,기차위삼련급이상용약강압점34.9％、단약강압점23.9％;단약강압방식최상견시CCB(점8.8％);쌍련강압방식최상견적조합시CCB+ ARB류(점11.7％);삼련급이상강압방식최상견적조합시CCB+ARB류+β-수체조체제(9.2％);(4)지남추천적규범용약인수987례,점76.6％;이련강압방식중규범연합용약적비례위71.9％;삼련급이상강압방식중규범연합용약적비례위66.1％.결론 노년관심병합병당뇨병고혈압환자접수강압적치료솔교고,단기혈압체표솔편저,주요적강압약물이ARB/ACEI류위주,CCB기차,이뇨제사용편소,주요적약물치료방식이연합강압위주,준순지남치료건의적의식유소제고,단잉수가강.
Objective To investigat the current status of blood pressure control rate and the use of antihypertensive drugs in elderly patients with coronary heart disease,diabetes mellitusand hypertension.Methods The elderly coronary heart disease patients with diabetes mellitus and hypertension (≥60 years old) were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011 in this multicenter,non-intervention and cross-sectional survey.The current status of blood pressure control rate in different antihypertensive target value,methods for application in antihypertensive drugs and standardized treatment recommended by guideline were investigated in the survey.Results 1 379 cases were eventually selected from the total 7 962 elderly patients (accounted for 17.3％).(1) The blood pressure control rate was 17.1％ for antihypertensive target value(＜ 130/80 mmHg) ; the control rate for 140/80 mmHg was 27.5％ ; the control rate for 140/90 mmHg was 39.6％ ;the success rate for 150/90 mmHg were 51.7％ ; control rate of elderly patient (≥70 years old) gradually increased with increasing of age; success rate of elderly patient(≥85 years old) was the highest,whereas control rate of elderly patient aged 71-71 years old was lowest; success rate for male patients was close to female patients,and success rate for men were slightly higher than those in women; (2) 1 347 cases had clear medication history(32 cases were missed) in the survey,1 317 effective cases received antihypertensive therapy (effective rate was 97.8％,1 317/1 347); the more commonly used drugs were angiotensin receptor blockers (ARB) /angiotensin converting enzyme inhibitors (ACEI) (usage rate was 76.8％),followed by dihydropyridine calcium channel blockers (CCB) (65.5％),β-blockers (usage rate was 44.6％),thiazide diuretics (26.3％) respectively; (3) combinations of two drugs was the most common way in antihypertensive medication (accounted for 41.2％),three drugs or more was 28.9％,and single drug was23.9％; CCB was the commonly used single drug (accounted for 8.8％) ; combinations of CCB and ARB were the most common way in combination of two drugs(11.7％),CCB combined with ARB and β-blockers was frequently used in combination of three drugs or more (9.2％) ; (4) 987 cases received standardized treatment recommended by guideline (accounted for 76.6％) ; the percentage of standardized usage in combinations of two drugs was 71.9％,the percentage of standard usage in combinations of three drugs or more was 66.1％.Conclusion The percentage of antihypertensive therapy is high,however,the overall blood pressure control rate is low.ACEI/ARB are the major drugs in antihypertensive medication,diuretic drugs are now rarely used; combined medication is the common method of antihypertensive therapy; the consciousness following the guidelines has improved,but still need to be strengthened.
