PDF(Pubmed)
Abstract：
it is not known if clinical practice reflects guideline recommendations for the management of hypertension in older people and whether guideline adherence varies according to overall health status.
to describe the proportion of older people attaining National Institute for Health and Care Excellence (NICE) guideline blood pressure targets within 1 year of hypertension diagnosis and determine predictors of target attainment.
a nationwide cohort study of Welsh primary care data from the Secure Anonymised Information Linkage databank including patients aged ≥65 years newly diagnosed with hypertension between 1st June 2011 and 1st June 2016. The primary outcome was attainment of NICE guideline blood pressure targets as measured by the latest blood pressure recording up to 1 year after diagnosis. Predictors of target attainment were investigated using logistic regression.
there were 26,392 patients (55% women, median age 71 [IQR 68-77] years) included, of which 13,939 (52.8%) attained a target blood pressure within a median follow-up of 9 months. Success in attaining target blood pressure was associated with a history of atrial fibrillation (OR 1.26, 95% CI 1.11, 1.43), heart failure (OR 1.25, 95% CI 1.06, 1.49) and myocardial infarction (OR 1.20, 95% CI 1.10, 1.32), all compared to no history of each, respectively. Care home residence, the severity of frailty, and increasing co-morbidity were not associated with target attainment following adjustment for confounder variables.
blood pressure remains insufficiently controlled 1 year after diagnosis in nearly half of older people with newly diagnosed hypertension, but target attainment appears unrelated to baseline frailty, multi-morbidity or care home residence.
to describe the proportion of older people attaining National Institute for Health and Care Excellence (NICE) guideline blood pressure targets within 1 year of hypertension diagnosis and determine predictors of target attainment.
a nationwide cohort study of Welsh primary care data from the Secure Anonymised Information Linkage databank including patients aged ≥65 years newly diagnosed with hypertension between 1st June 2011 and 1st June 2016. The primary outcome was attainment of NICE guideline blood pressure targets as measured by the latest blood pressure recording up to 1 year after diagnosis. Predictors of target attainment were investigated using logistic regression.
there were 26,392 patients (55% women, median age 71 [IQR 68-77] years) included, of which 13,939 (52.8%) attained a target blood pressure within a median follow-up of 9 months. Success in attaining target blood pressure was associated with a history of atrial fibrillation (OR 1.26, 95% CI 1.11, 1.43), heart failure (OR 1.25, 95% CI 1.06, 1.49) and myocardial infarction (OR 1.20, 95% CI 1.10, 1.32), all compared to no history of each, respectively. Care home residence, the severity of frailty, and increasing co-morbidity were not associated with target attainment following adjustment for confounder variables.
blood pressure remains insufficiently controlled 1 year after diagnosis in nearly half of older people with newly diagnosed hypertension, but target attainment appears unrelated to baseline frailty, multi-morbidity or care home residence.
摘要：
背景：目前尚不清楚临床实践是否反映了老年人高血压管理的指南建议，以及指南依从性是否因总体健康状况而异。
目的：描述在高血压诊断后1年内达到美国国家健康与护理卓越研究所（NICE）指南血压目标的老年人比例，并确定达到目标的预测因素。
方法：一项来自安全匿名信息链接数据库的威尔士初级保健数据的全国队列研究，包括2011年6月1日至2016年6月1日期间新诊断为高血压的65岁以上患者。主要结果是达到NICE指南血压目标，通过诊断后1年的最新血压记录来测量。使用逻辑回归研究了目标达成的预测因素。
结果：有26,392名患者（55％为女性，包括中位年龄71[IQR68-77]岁），其中13,939人(52.8%)在9个月的中位随访时间内达到目标血压。成功达到目标血压与房颤病史相关(OR1.26,95%CI1.11,1.43),心力衰竭(OR1.25,95%CI1.06,1.49)和心肌梗死(OR1.20,95%CI1.10,1.32),与没有历史的每个人相比，分别。疗养院住宅，脆弱的严重性，在校正混杂变量后,合并症的增加与目标达成无关.
结论：近半数新诊断高血压的老年人在诊断1年后血压仍未得到充分控制，但是目标达成似乎与基线脆弱无关，多发病率或护理家庭居住。
目的：描述在高血压诊断后1年内达到美国国家健康与护理卓越研究所（NICE）指南血压目标的老年人比例，并确定达到目标的预测因素。
方法：一项来自安全匿名信息链接数据库的威尔士初级保健数据的全国队列研究，包括2011年6月1日至2016年6月1日期间新诊断为高血压的65岁以上患者。主要结果是达到NICE指南血压目标，通过诊断后1年的最新血压记录来测量。使用逻辑回归研究了目标达成的预测因素。
结果：有26,392名患者（55％为女性，包括中位年龄71[IQR68-77]岁），其中13,939人(52.8%)在9个月的中位随访时间内达到目标血压。成功达到目标血压与房颤病史相关(OR1.26,95%CI1.11,1.43),心力衰竭(OR1.25,95%CI1.06,1.49)和心肌梗死(OR1.20,95%CI1.10,1.32),与没有历史的每个人相比，分别。疗养院住宅，脆弱的严重性，在校正混杂变量后,合并症的增加与目标达成无关.
结论：近半数新诊断高血压的老年人在诊断1年后血压仍未得到充分控制，但是目标达成似乎与基线脆弱无关，多发病率或护理家庭居住。
