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首页> 美国卫生研究院文献>other >The Association between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure: Findings from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
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The Association between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure: Findings from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

机译：降压药物不依从性与血压的就诊就诊变异性之间的关联：降压和降脂治疗预防心脏病发作试验的发现（ALLHAT）

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Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using standard deviation independent of the mean (SDIM), standard deviation, and average real variability across study visits conducted 6 to 28 months following randomization. Participants who reported taking <80% of their antihypertensive medication at one or more study visits were categorized as nonadherent. Participants were followed for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SDIM of BP was higher for nonadherent (n=2,912) versus adherent (n=16,878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP (SBP); 6.8±2.8 versus 6.2±2.6 for diastolic BP (DBP) (each p<0.001). SDIM of BP remained higher among nonadherent versus adherent participants after multivariable adjustment [0.8 (95%CI 0.7–1.0) higher for SBP and 0.4 (95%CI 0.3–0.5) higher for DBP]. Standard deviation and average real variability of SBP and DBP were also higher among nonadherent versus adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or non-fatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence.
机译：假设对降压药依从性较低会增加血压（BP）的就诊访视变异性（VVV）。我们评估了在预防高血压和降脂治疗心脏病发作试验中的降压药物依从性与BP VVV之间的关联性。使用随机数后6到28个月进行的研究访视的标准差独立于均值（SDIM），标准差和平均实际变异性来计算BP的VVV。在一次或多次研究访问中报告服用其降压药的80％以下的参与者被归类为不依从。在评估BP的依从性和VVV后，随访参与者的心血管事件和死亡率。非依从者（n = 2,912）的BP SDIM高于依从者（n = 16,878）。收缩压（SBP）分别为11.4±4.9和10.5±4.5;舒张压BP（DBP）为6.8±2.8，而6.2±2.6（每个p <0.001）。经过多变量调整后，非依从者和依从者的血压SDIM仍然较高[SBP升高0.8（95％CI 0.7-1.0），DBP升高0.4（95％CI 0.3-0.5）]。在非依从性参与者与依从性参与者之间，SBP和DBP的标准差和平均实际变异性也更高。调整不依从性并不能解释BP的VVV与更高的致命性冠心病或非致命性心肌梗塞，中风，心力衰竭或死亡风险的相关性。总之，改善药物依从性可能会降低BP的VVV。但是，BP的VVV与心血管结果相关，与药物依从性无关。

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