原发性高血压患者药物治疗依从性的影响因素分析

目的 了解住院原发性高血压患者遵医嘱用药状况,分析影响原发性高血压患者服药依从性的原因.方法 应用自行设计的问卷,对315例住院原发性高血压患者的药物治疗依从性进行调查,并对结果进行分析.结果 本组患者的服药依从率为33.65%,不依从率为66.35%.不依从的原因主要是因好转而停药、忘记服药、不知道高血压需长期服药、害怕药物的不良反应等.结论 护士要有针对性的对患者进行健康教育,改变患者不正确的治疗观念,不断提高患者的依从行为.     

高血压患者服药依从性的影响因素及护理对策

目的探讨高血压患者坚持服药治疗的影响因素及相应的护理对策。方法对我院已确诊并建立档案的680例原发性高血压患者服药情况进行调查,对服药依从性影响因素进行分析。结果服药依从性佳者328例,依从率48．24％。影响服药依从性的因素有性别、年龄、文化程度、家庭经济、亲友病史、高血压常识、血压升高程度、药物不良反应、药费贵等因素。结论高血压患者坚持服药的影响因素多种多样,提高服药率的关键是采用有针对性的个性化措施和积极的护理策略。     

2型糖尿病患者口服降糖药物依从性研究

目的：探讨2型糖尿病住院和门诊患者口服降糖药物的依从性及其相关因素。方法：回顾性分析1998年7月至2003年7月2型糖尿病住院患者258例和门诊随访患者137例的降糖药物依从性及其相关因素；调查降糖药物的使用情况和药物副作用的发生率，观察药物依从者和不依从者的血糖水平变化。结果：2型糖尿病住院病人出院后53．1％的病人来院门诊随访，住院期间药物依从率为68．6％，出院时出院带药的依从率为81．8％，门诊随访期间药物依从率为40．9％，药物不依从的原因包括：药物副作用、血糖控制不佳、经济原因等，门诊随访过程中，磺脲类的副作用明显增加，药物依从者血糖控制佳，而不依从者血糖控制不佳。结论：出院后对出院带药的依从性最佳，住院期间的药物依从性次之，门诊随访期间的药物依从性最差。     

原发性高血压病人用药依从性影响因素的研究

目的探讨影响原发性高血压患者药物依从性的因素,为患者提高服药依从性提供依据。方法对我院200例确诊的原发性高血压病人进行用药情况及其相关因素的问卷调查,采用多元Logistic回归对用药依从性影响因素进行分析。结果原发性高血压病人用药依从率为29.38%,影响其用药依从性的因素有患者经济状况、高血压病情轻重、病人对高血压病知识了解多少、病人就医频率高低(P<0.05)。结论选择经济的药物,对原发性高血压患者进行健康管理和健康教育,提高其对疾病的认知度,可提高服药依从性。     

偏远山区高血压病人治疗依从性与血压控制情况调查

[目的]了解偏远山区高血压病人治疗依从性及血压控制情况。[方法]采用彭志勇编制的高血压用药依从性调查问卷对入选的162例高血压病人进行调查。[结果]偏远山区高血压病人服药依从率为29．6％;依从性低的主要原因为就医不方便、对高血压病缺乏认识（忘记服药）、自觉不严重等;血压控制率为48．1％。[结论]偏远山区高血压病人对治疗的依从性差,血压控制率很不乐观;最主要原因是就医不方便、对高血压病相关知识缺乏了解。     

老年高血压患者服药依从性的社区调查研究

目的了解老年高血压患者的服药依从率及影响服药依从性的原因，以便进一步提高高血压的控制率。方法选择2012年来我院体检的288名老年高血压患者为对象，通过健康体检和门诊治疗以及问卷调查对其进行观察，并对288例老年高血压患者的服药依从性进行统计分析。结果288例老年高血压患者中，服药依从性佳者28.8%，不同年龄组60～69岁组、70～79岁组、80～89岁组、90岁以上组服药依从率分别为22.8%、28.1%、32.6%、37.5%；依从率随年龄增长而升高。病程10年以下组服药依从率为19.6%，病程≥10年组服药依从率为33.5%。依从性不佳者中，21.0%的患者是认为没有不适不必服药，17.6%是经常忘记服药，14.6%归因于就诊不方便，13.6%的老年人认为没有必要天天服药。结论对老年高血压患者可以采取加强高血压健康教育、加强督导促进患者服药、积极开展上门诊疗以及为患者开具合理、有效、性价比高、个体化的降压药、建立良好的医患关系、提高社会支持等方法提高其服药依从性，以进一步提高高血压的控制率。     

中青年原发性高血压128例治疗依从性调查分析

目的:探讨中青年原发性高血压(简称高血压)患者对治疗的依从性.方法:用自制的调查问卷对128例中青年原发性高血压患者进行有关服药依从性及生活方式依从性的调查,具体内容包括药物治疗、运动治疗、饮食控制、戒除烟酒、控制体重、定期复查及门诊随访等,并分析相关原因,提出解决方法.结果:本组对药物治疗、定期复查及门诊随访的依从性相对较好,但仅有一半以上的患者做到完全依从医师的治疗,而对于运动治疗、戒除烟酒、饮食控制及控制体重的依从性较差;随着病程的进展,药物治疗的完全依从性逐渐减少,且病程≤1年患者的药物治疗依从性与病程≥3年的比较,有显著性差异(P＜0.05).结论:中青年原发性高血压患者的服药依从性及生活方式依从性均较差,需要加强健康教育.     

社区抗高血压药物用药情况和依从性调查

目的探讨社区高血压患者降压药物的依从性及其相关因素。方法调查并回顾性分析社区高血压病患者1648例的降压药物依从性及其相关因素；调查降压药物的使用情况和药物副作用的发生率；观察药物依从者和不依从者的血压水平变化。结果社区高血压患者的心血管危险因素分层前几位依次为脂质代谢紊乱、吸烟、左心室肥厚和糖尿病。30．1％的患者曾住院治疗，36．5％的患者在社区保健院门诊随访，63．5％的患者在医院门诊随访。在社区和医院门诊随访期间的药物依从性分别为48．3％和47.9％。药物不依从的原因包括：药物副作用、血压控制不佳、经济原因等。药物依从者血压控制佳，波动小；而不依从者血压控制不佳，波动大。结论在社区和医院门诊随访期间的药物依从性无明显差异。     

住院精神分裂症患者稳定期服药不依从相关因素及应对措施探讨

目的探索改善住院精神分裂症患者稳定期服药不依从的有效措施。方法将168例住院精神分裂症患者稳定期服药不依从者随机分为研究组和对照组各84例,研究组在针对服药不依从原因常规处理基础上进行为期8周的系统健康教育,对照组只针对服药不依从原因进行常规处理,8周后再连续4周密切观察两组的服药依从性。所有资料经χ^2检验进行统计分析。结果住院精神分裂症患者稳定期服药不依从的首要原因是不知道正确的治疗方法;系统健康教育结束后4周内两组间服药依从性比较差异有统计学意义（P〈0．05）;精神分裂症患者病程早期两组间服药依从性比较差异有统计学意义（P〈0．05）;而晚期两组间差异无统计学意义（P〉0．05）。结论系统健康教育能有效提高住院精神分裂症患者稳定期服药不依从的依从性。     

偏远山区高血压病人治疗依从性与血压控制情况调查

[目的]了解偏远山区高血压病人治疗依从性及血压控制情况.[方法]采用彭志勇编制的高血压用药依从性调查问卷对入选的162例高血压病人进行调查.[结果]偏远山区高血压病人服药依从率为29.6％;依从性低的主要原因为就医不方便、对高血压病缺乏认识(忘记服药)、自觉不严重等;血压控制率为48.1％.[结论]偏远山区高血压病人对治疗的依从性差,血压控制率很不乐观;最主要原因是就医不方便、对高血压病相关知识缺乏了解.     

高血压患者有关该病知识、信念及其对治疗依从性的影响

对１４９例高血压患者一般情况、高血压知识得分、健康信念、服药依从性进行调查，发现病人的服药依从性主要受患者的健康信念和疾病知识的影响，认为治疗高血压是有益者服药依从性较高，认为治疗高血压是有害者、没有必要者服药依从性较低，高血压知识越多，服药依从性越差。说明在临床高血压的治疗过程中，医护人员在开展高血压的临床治疗过程中仅通过健康教育的手段增加病人的知识，来促进病人的服药依从行为是不够的，同时还要注意每个病人健康信念的特殊性，据此制定合理的健康教育方案，矫正其错误的健康信念，建立正确的健康信念，依此来促进病人遵守医嘱行为     

老年高血压病患者停服降压药物的原因分析

目的为了调查老年高血压病患者停服降压药物的原因,以提高老年高血压患者的治疗效果.方法采用面谈和查阅患者病历的方法,调查115例高血压病患者停服降压药物的原因及其动态血压检测结果,然后进行数据统计和分析.结果 115例停服降压药物的原因分别为多次测量血压偏低、对高血压病了解不够、对降压药物了解不够、服药方案过于复杂、老年患者记忆力较差、一时配不到同种药物,其中因血压偏低而停药患者(血压控制率为77.35%)与因其他原因而停药患者(血压控制率为33.87%)比较,差异有统计学意义(P＜0.001).结论对患者加强健康教育,定期检测血压,以提高血压控制率.     

Long-term dispensary observation of patients with so-called low-renin forms of arterial hypertension

The authors provided an analysis of the results of 3-year follow-up and therapy of 32 patients with hypertension developing with blood renin low activity. A prolonged, statistically significant decrease in the AP level with the improvement of the patients' subjective status was noted in continuous adequate hypotensive therapy. The most severe clinical course was observed in the group of patients with unresected adrenal adenoma. During treatment of patients with primary aldosteronism with spironolactone one should pay attention to the presence of some concomitant diseases (mastopathy, myoma of the uterus) because this drug may turn their course unfavorably, thus making the treatment of patients with adrenal pathology difficult.     

Assessment of compliance with antipsychotic treatment and resource utilization in a Medicaid population

BACKGROUND: Partial compliance with mental health medications has been associated with an increased risk of clinical worsening, relapse, and repeat hospitalization. OBJECTIVE: The purpose of this study was to evaluate the effect of partial compliance of patients (diagnosed as having schizophrenia or bipolar disorder) with prescribed oral atypical and conventional antipsychotic agents and the corresponding impact on resource utilization. METHODS: Patients receiving antipsychotic agents ina large Southeastern Medicaid program were grouped according to their level of compliance. Compliance was measured by the continuous, multiple interval medications available methodology. Patients were deemed partially compliant if compliance was <80%, compliant if compliance was 80% to 125%, and overly compliant if compliance was >125%. Medical costs were modeled as a function of compliance while controlling for background covariates. Logistic regression was used to model the probability of specific resource utilization. RESULTS: A total of 7864 patients were included in this analysis. After controlling for background covariates, partially compliant patients were 49.0% (95% CI, 29.2%-71.7%) more likely than compliant patients to have an inpatient hospitalization and incurred 54.5% (P < 0.001) higher inpatient charges. Partially compliant patients were also 64% (P < 0.01) more likely than compliant patients to switch or augment therapy. CONCLUSION: Partial compliance was associated with an increased risk of hospitalization and switching or augmentation of therapy when compared with being compliant.     

Sildenafil for primary and secondary pulmonary hypertension

BACKGROUND: Sildenafil is a selective inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase type 5, an enzyme that is abundant in both lung and penile tissues. Sildenafil is widely used to dilate penile arteries, suggesting that it may also dilate pulmonary arteries in patients with pulmonary hypertension. However, the long-term hemodynamic effects and safety of the drug in pulmonary hypertension are not known. METHODS: One patient with primary pulmonary hypertension and another with secondary pulmonary hypertension caused by collagen disease were given 50 mg oral sildenafil during cardiac catheterization for assessment of the acute hemodynamic effects of the drug. The patients were then given maintenance treatment with 25 mg oral sildenafil twice a day. Long-term hemodynamic effects were evaluated by repeated cardiac catheterization after 3 months, with the last oral dose given 15 hours before the procedure. The acute hemodynamic effects of sildenafil after the long-term treatment were studied during the same cardiac catheterization. RESULTS: Sildenafil did not affect aortic pressure, but it significantly decreased pulmonary artery pressure and increased cardiac index, thereby reducing pulmonary vascular resistance. Long-term maintenance therapy with 25 mg oral sildenafil twice a day remarkably improved the clinical condition of the patients, without causing any adverse effects; New York Heart Association functional classification returned to class II (from class III). The acute efficacy of sildenafil was well preserved after the long-term treatment; there was no tolerance. CONCLUSIONS: The data strongly suggest that sildenafil can be used as a valuable pulmonary vasodilator in patients with pulmonary hypertension, with good long-term hemodynamic effects and safety. The results necessitate larger trials to confirm these observations in a larger cohort of patients.     

对高血压病人实施健康教育的效果观察

目的 :了解健康教育对高血压病人血压的调节作用。方法 :对 182例轻度高血压病人 ,在未经药物治疗或停服降压药 1周以上 ,采用无创便携式动态血压监测仪进行 2 4h动态血压监测(ABPM )。对病人实施健康教育 ,观察 2周后 ,重复 2 4hABPM。结果 :实施健康教育措施后 ,血压波动幅度明显下降 ,且昼夜血压负荷大于 5 0 %以上病人人数明显减少。结论 :健康教育对高血压病人的血压有调节作用 ,有利于血压趋于平稳 ;在正规药物治疗前 ,健康教育可作为轻度高血压的药物治疗前的基础治疗。     

社区健康教育对高血压病人生活方式及服药依从性的影响

目的 探讨社区家庭健康教育对高血压病患者生活方式及服药依从性的影响.方法 120例高血压患者随机分为干预组、对照组各60例,对照组单纯对患者本人进行健康教育,干预组在对患者进行健康教育的同时,将患者家庭成员纳入健康教育的范围,两组在健康教育前后进行生活方式和服药依从性的评价.结果 在改善患者生活方式、提高服药依从性、改善血压方面,两组相比P<0.01,差异有统计学意义.结论 对患者本人及其家庭成员进行社区健康教育,较单纯对患者本人进行健康教育,可以更好地改善患者的生活方式、提高服药依从性,改善患者血压.     

Controversies in the management of hypertension

Despite recent controversies in hypertension management, family physicians can confidently follow a straightforward diagnostic and treatment approach. Routine use of echocardiography or 24-hour ambulatory monitoring is not recommended in the initial work-up of hypertension. The optimum goal for the diastolic blood pressure remains at 80 to 85 mm Hg. As many as 20 to 25 percent of patients with mild hypertension become normotensive with dietary modifications, exercise and alcohol cessation. In patients with mild hypertension, these nonpharmacologic approaches should be tried for three to six months before drug therapy is instituted. Initial drug therapy should be chosen on the basis of effectiveness, ease of administration, tolerability, cost and long-term safety record. Many of the reported adverse metabolic effects of diuretics may be of limited clinical significance. Despite the availability of newer antihypertensives, diuretics remain a choice in most patients as initial therapy or as a step-2 drug.     

Medicaid prescriber compliance with Joint National Committee VI Hypertension Treatment Guidelines

BACKGROUND: Since the early 1970s, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) has been tasked with the formulation of national guidelines for the management of hypertension. These were significantly changed in 1993 with publication of JNC-5. JNC-6 kept many basic treatment recommendations (i.e., initiation of therapy with a thiazide diuretic or beta-blocker), partly in response to the low adoption rate of the treatment recommendations of JNC-5. OBJECTIVE: To describe single-drug outpatient therapy of hypertension and temporally correlate these therapies with the publication of JNC-5 and JNC-6. METHODS: The electronic records of randomly selected New York State Medicaid recipients without hospitalization who had a diagnosis of hypertension and who were receiving only 1 antihypertensive medication were analyzed for 1994, 1997, and 1999. This analysis identified the medications selected for monotherapy of hypertension and compared these therapies with JNC recommendations. The analysis was correlated to patient comorbidities to further account for provider selection of a non-first-line agent. RESULTS: In 1994, angiotensin-converting enzyme (ACE) inhibitors and calcium-channel blockers accounted for 69% of therapies, with 67.5% of these patients having no JNC-recognized individualizing consideration for their use. In 1999, the combined use of ACE inhibitors and calcium-channel blockers accounted for over 65% of all single-drug therapy; 60% of these patients had no individualizing considerations. Also, in 1999, 47.7% of all patients appeared to be receiving antihypertensive therapies that are not compliant with JNC recommendations. CONCLUSIONS: Single-drug therapy of hypertension in a nonhospitalized New York state Medicaid population from 1994 through 1999 did not closely follow JNC recommendations for the single-agent treatment of hypertension.     

Alendronate adherence and its impact on hip-fracture risk in patients with established osteoporosis in Taiwan

A pharmacoepidemiology study was conducted using the health insurance database in Taiwan to assess compliance with osteoporosis drug regimens and the impact of compliance on the risk for secondary fractures. Patients >50 years of age with vertebral/hip fracture who had been started on alendronate therapy for the first time only after the fracture were included. Compliance was measured using the medication possession ratio (MPR) and was included as a time-dependent covariate in the Cox model to compare the difference between compliant (MPR ≥ 80%) and noncompliant patients (MPR <80%) with respect to risk for subsequent hip fractures. Only 38% of the study population remained compliant during the first year of treatment. Over the 4-year follow-up period, the risk of hip fracture among the compliant patients was 70% lower than that among the noncompliant ones (adjusted hazard ratio (HR) 0.30). Among patients with osteoporosis in Taiwan who had experienced a fracture and had started alendronate therapy, compliance with the dosage regimen was suboptimal. It was also found that compliance significantly reduced the risk of secondary hip fracture up to 4 years.