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目的了解中国冠心病患者血压控制及降压药物使用情况,分析影响血压控制的因素。方法借助国际多中心大规模临床试验HPS2-THRIVE在中国实施之际,在14座城市的51家医院中对冠心病患者进行调查。利用电子问卷,收集基本情况、病史、吸烟、饮酒和用药资料,测量血压及身高、体质量和腰围,计算达标率。结果 2007年6月至2009年10月期间共调查冠心病患者13 015例,年龄50～80岁,平均(63±8)岁。8033例患者(61.7%)已知明确的高血压病史,其中90.6%服用降压药物,仅30.1%血压控制达标。50～59岁、60～69岁和70～80岁年龄组达标率分别为35.8%、29.3%和25.0%。未服药组、服用1种药物组、服用2种药物组和服用3种及以上组的血压达标率分别为21.1%、26.8%、32.3%和34.9%。大量饮酒者、合并糖尿病或缺血性脑卒中的患者血压达标率(分别为23.8%、19.8%和24.4%)明显低于无此情况者(分别为29.8%、39.5%和32.2%)。相反,接受经皮冠状动脉介入治疗、冠状动脉旁路移植术和服用他汀类药物者血压达标率(分别为35.2%、32.0%和35.2%)均高于无此情况者(分别为25.1%、29.8%和23.2%)。无高血压病史的患者中,仅58.9%血压正常。结论中国冠心病患者血压控制情况距指南要求仍存在很大差距,在大量饮酒以及合并糖尿病或脑卒中的患者中更为突出。
Objective To understand the blood pressure control and the use of antihypertensive drugs in patients with coronary heart disease in China and analyze the factors influencing blood pressure control. Methods With the help of HPS2-THRIVE, an international multicentre large-scale clinical trial conducted in China, coronary heart disease patients were investigated in 51 hospitals in 14 cities. Use of electronic questionnaires to collect basic information, medical history, smoking, drinking and medication information, measuring blood pressure and height, weight and waist circumference, calculate compliance rate. Results A total of 13 015 coronary heart disease patients were surveyed from June 2007 to October 2009, aged from 50 to 80 years, with an average of (63 ± 8) years. 8033 patients (61.7%) have known a clear history of hypertension, of which 90.6% take antihypertensive drugs, only 30.1% of blood pressure control compliance. The compliance rates of 50 to 59 years old, 60 to 69 years old and 70 to 80 years old group were 35.8%, 29.3% and 25.0% respectively. The standard rates of blood pressure were 21.1%, 26.8%, 32.3% and 34.9% in the non-medication group, taking one drug group, taking two drug groups and taking three or more groups respectively. Blood pressure compliance rates (23.8%, 19.8%, and 24.4%, respectively) were significantly lower in those who drunk, those with diabetes, or those with ischemic stroke than those without (29.8%, 39.5%, and 32.2%, respectively). In contrast, percutaneous coronary intervention, coronary artery bypass grafting, and blood pressure compliance with statins (35.2%, 32.0%, and 35.2%, respectively) were higher than those who did not (25.1% 29.8% and 23.2%). Of the patients without a history of hypertension, only 58.9% were normotensive. Conclusion The prevalence of BP control in Chinese patients with coronary heart disease still lags far behind the guidelines, and is even more conspicuous in patients who drink alcohol heavily or who have diabetes or stroke.