Arleen Aune, Annabel Ohldieck, Lene V Halvorsen, Karl Marius Brobak, Eirik Olsen, Stine Rognstad, Anne Cecilie K Larstorp, Camilla L Søraas, Anne B Rossebø, Assami Rösner, Marianne Aa Grytaas, Eva Gerdts
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Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication.</p><p><strong>Results: </strong>Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30-3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17-3.10], p = 0.010), while no association with drug nonadherence was found. 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引用次数: 0
摘要
导言：女性高血压患者比男性高血压患者更容易出现左心室（LV）肥厚和左心房（LA）扩大等心脏器官损伤，但这种性别差异的机制仍不清楚：我们通过超声心动图检测了186名女性和337名男性高血压患者不遵医嘱用药与左心室肥厚和左心房增大的关系，不遵医嘱用药的定义是：尽管处方中至少有两种降压药，但日间收缩压（BP）≥135mmHg。由经验丰富的药剂师通过测量血清药物浓度来评估服药依从性。醛固酮-肾素比率（ARR）根据实际用药情况进行测量：结果：女性左心室肥厚（46% 对 33%）和 LA 肥大（79% 对 65%，P 均为 0.514）的发生率没有差异。女性的年龄比男性大，血清肾素浓度比男性低，ARR比男性高，而24小时收缩压（141 ± 9 mmHg vs. 142 ± 9 mmHg）和肥胖率（43% vs. 50%）没有差异（均为P > 0.10）。在多变量分析中，女性性别与左心室肥厚（OR 2.01[95% CI 1.30-3.10]，P = 0.002）和 LA 扩大（OR 1.90[95% CI 1.17-3.10]，P = 0.010）风险增加两倍独立相关，而与不遵医嘱用药没有关联。仅在男性中，较高的ARR与左心室肥厚独立相关（OR 2.12 [95% CI 1.12-4.00] p = 0.02）：结论：在未得到控制的高血压患者中，女性左心室肥厚和LA增大的发生率较高，但这并不能用不依从性差异来解释：URL: https://www.Clinicaltrials: gov ; Unique identifier：NCT03209154.
Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence.
Introduction: Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear.
Methods: We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication.
Results: Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30-3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17-3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12-4.00] p = 0.02).
Conclusions: Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence.
期刊介绍：
High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes: Invited ''State of the Art'' reviews. Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.
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