基于重复测量的不同用药方案和血压水平高血压患者报告结局比较

Repeated measures-based comparison of patient-reported outcomes for patients with hypertension having different medication regimens and blood pressure levels

摘要:

目的 基于患者报告的临床结局（patient reported outcomes，PRO）比较不同血压水平的高血压患者对于不同用药方案的治疗效果，为临床医生选择用药方案提供线索。方法 对正在服用降压药物的625例社区高血压患者进行PRO基线测量，并每3个月测量1次，共重复测量3次。采用重复测量方差分析法，分析比较不同时间点2种用药方案（单一用药、联合用药）和3种血压水平（1级高血压、2级高血压、3级高血压）构成的6种组合的PRO差异。结果 重复测量方差分析结果显示，不同用药方案、血压水平的高血压患者在3次重复测量后PRO得分产生不同程度的波动。单一用药的1级高血压患者，身体健康、心理健康、社会健康、精神/信仰健康、特异模块领域的PRO得分均波动下降；单一用药的2级、3级高血压患者，心理健康、社会健康、精神/信仰健康领域得分均波动上升。联合用药的1级、2级、3级高血压患者身体健康领域PRO得分没有差异。联合用药的2级高血压患者心理健康领域得分呈下降趋势。联合用药的3级高血压患者社会健康得分呈波动上升趋势。联合用药的1级高血压精神/信仰健康得分呈波动下降趋势，2级高血压精神/信仰健康得分呈上升趋势。联合用药的2级高血压患者特异模块得分呈下降趋势。从量表总分看，1级高血压患者，无论是单一用药还是联合用药PRO得分均下降，2级高血压和3级高血压患者使用单一用药和联合用药时PRO得分均呈波动上升趋势。结论 不同血压水平的高血压患者对于单一用药和联合用药治疗后PRO得分不同，临床医生在选择用药方案时可参考患者的PRO。

Abstract:

Objective To compare the therapeutic effects of different medication regimens in patients with hypertension with different blood pressure levels based on patient reported outcomes（PROs），and to provide a reference for clinicians to choose medication regimens.Methods A total of 625 community patients with hypertension who were taking antihypertensive medications underwent a baseline PRO measure and three repeated-measures of PRO（once every three months）. Repeated-measures analysis of variance （ANOVA） was used to compare the PRO of six combinations generated with two medication regimens（single medications and combined medications） and three blood pressure levels（grade-1 hypertension，grade-2 hypertension，and grade-3 hypertension） at different time points.Results Repeated-measures ANOVA results showed that patients with hypertension having different medication regimens and blood pressure levels had varying degrees of fluctuations in PRO scores across three repeated measures. For patients with grade-1 hypertension on single medications，PRO scores in physical health，mental health，social health，spiritual/faith-related health，and the specific module fluctuated downward. For both patients with grade-2 hypertension and those with grade-3 hypertension on single medications，the scores in mental health，social health，and spiritual/faith-related health fluctuated upward. There were no significant differences in PRO scores in physical health among grade-1，-2，and -3 hypertensive patients on combined medications. There was a downward trend in mental health-related PRO score in patients with grade-2 hypertension on combined medications. The PRO score in social health showed a fluctuating upward trend in patients with grade-3 hypertension on combined medications. For patients with grade-1 hypertension and those with grade-2 hypertension on combined medications，the PRO score in spiritual/faith-related health fluctuated downward and upward，respectively. There was a downward trend in the specific module score of patients with grade-2 hypertension on combined medications. The total PRO score declined in patients with grade-1 hypertension and fluctuated upward in patients with grade-2 and grade-3 hypertension，regardless of single or combined medications.Conclusion Patients with different grades of hypertension have varying PRO scores with single and combined medications，and clinicians can refer to patients’ PROs when choosing medication regimens.