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고혈압 환자에서 항고혈압 약물 3종 복합제 사용 후 목표혈압 달성의 연관 요인

Associated Factors for Target Blood Pressure Achievement after Triple Combination Therapy in Hypertensive Patients

김영식|김선미|이상엽|강서영|정소현|양윤준|전태희|전예림|윤종률
대한임상건강증진학회 (Korean Society For Health Promotion And Disease Prevention)|2019.03|Korean Journal of Health Promotion|제19권 제1호|pp. 16-24

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혈압고혈압HypertensionControlBlood pressure조절률Combination drug therapy병용요법
주제분류기타자연과학

초록

연구배경: 고혈압의 유병률은 30세 이상 성인의 29%에 달하지만, 조절률은 44%에 불과하다. 본 연구의 목적은 고혈압 환자에서 항고혈압 약물 3종 복합제 사용 후 목표혈압달성 관련 요인을 조사하는 것이다. 방법: 2016년 2월부터 2018년 5월까지 국내 가정의학과의사 10명에게 방문한 고혈압 환자 중에서 항고혈압 약물3종 복합제를 처음 복용하기 시작한 348명의 환자를 선정하였다. 목표혈압은 항고혈압 약물 3종 복합제 투약 6개월 후수축기 혈압 140 mmHg 및 이완기 혈압 90 mmHg 미만으로정의하였다. 로지스틱 회귀분석을 수행하여 목표혈압 달성관련 요인을 분석하였다. 결과: 348명의 연구 참가자 중 317명이 6개월 동안 항고혈압 약물 3종 복합제를 복용하였으며, 목표 달성률은 76.3% (242/317)였다. SBP와 DBP의 평균 절대차와 95% 신뢰구간은 각각 -10.8 mmHg (-12.7 to -8.9), -6.4 mmHg (-7.8 to -5.1)이었다. 목표혈압 달성에 대한 오즈비는 대학교 졸업이상인 경우(OR, 2.69; 95% CI, 1.22-5.92), 이상지질혈증이동반된 경우(OR, 1.74; 95% CI, 1.01-2.99), 약물 치료에 만족한 경우(OR, 29.91; 95% CI, 3.70-241.92) 증가하였다. 결론: 본 연구에서 이상지질혈증 동반, 약물에 대한 환자만족도는 목표혈압 달성과 관련이 있었다. 본 연구 결과는혈압조절에 있어서 환자 요인이 중요하게 작용할 수 있다는것을 시사한다.

Abstract

Background: The prevalence of hypertension reaches 29% in adults over 30 years of age in the Korean population; however, the control rate is merely 44%. The aim of this study was to investigate the associated factors for target blood pressure achievement after triple combination therapy in hypertensive patients. Methods: From February 2016 to May 2018, 10 family physicians recruited 348 patients, who newly started a triple combination antihypertensive medication. Target blood pressure was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg after 6 months of triple combination therapy. Multivariate logistic regression analyses were performed to analyze the associated factors for target blood pressure achievement. Results: Among the 348 study participants, 317 completed 6 months of treatment. The target achievement rate was 76.3% (242/317). The mean absolute difference and 95% confidence interval (CI) for the SBP and DBP were 10.8 mmHg (8.8 to 12.7) and 6.4 mmHg (5.1 to 7.8), respectively (P<0.05). The odds ratio (OR) for the target blood pressure achievement increased in those with college education or higher (OR, 2.69; 95% CI, 1.22-5.92), those with dyslipidemia (OR, 1.74; 95% CI, 1.01-2.99), and those who were satisfied with the medication (OR, 29.91; 95% CI, 3.70-241.92). Conclusions: The presence of dyslipidemia and patient’s satisfaction with the medication were associated with target blood pressure achievement in our analyses. Our findings suggest the importance of patient’s factor in the control of blood pressure.

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