【论著】在具有高危心血管病风险的高血压患者中评估家庭血压监测与血压控制的关联关系

在《心血管病探索（英文）》2024年1期中，李静教授团队发表了“在具有高危心血管病风险的高血压患者中评估家庭血压监测与血压控制的关联关系”。

家庭血压监测（Home blood pressure monitoring，HBPM）被认为是高血压治疗初期诊断和长期管理的一个促进因素。然而，HBPM在真实世界中有效性的证据仍然很少。本研究旨在探讨HBPM与血压控制及药物依从性的关系。

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Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China

摘要

Objective:

Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence.

Methods:

This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment.

Results:

A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6±7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of antihypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6±10.8) mmHg and (81.9±10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11–1.72, P = 0.004).

Conclusions:

HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients’ misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.

Keywords:

Hypertension; Home blood pressure monitoring; Blood pressure control; Medication adherence

作者简介

李 静（通信作者）

研究员、博士生导师。国家心血管病中心预防医学处处长、中国医学科学院阜外医院国家心血管疾病临床医学研究中心副主任、心血管药物临床研究重点实验室副主任 

Citation: Li J, Tian A, Liu J, et al. Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China. Cardiol Discov 2024;4(1):15–22. doi: 10.1097/CD9.0000000000000118