| Objective: To contrast the visit-to-visit blood pressure variability(BPV)? total effectiveness rate,target rate and blood pressure after treatment between nitrendipine combined with hydrochlorothiazide or betaloc of rural low-cost treatment plan,analyzing the characteristics of uncontrolled registers and factors affect the standard rate.Methods: We selected the data from “Research and Economic Evaluation of Low-cost Antihypertensive program in Rural Areas” of Jilin Provence,based on National Science and Technology Support Program for Twelfth Five-Year Plan.From March to April,400 patients with 2-grade or severe hypertension in Dong Feng and Jing Yu countries were recruited.They were divided into two groups randomly after two weeks washout period,named nitrendipine combined with hydrochlorothiazide or nitrendipine combined with betaloc.Follow-up visits were conducted on the first day and the 2nd?4th?6th?8th weekend and 4th?6th month of medication,including the blood pressure,heart rates,and so on.During the follow-up period,the medicine would be adjusted or added according to the titration process if the blood pressure uncontrolled.At the beginning and the end of the treatment,two laboratory tests were performed,including the blood biochemistry?plasma glucose ?plasma lipid.SPSS22.0 software was used for data analysis.Measurement data conformed to normal distribution was registered as mean ± standard deviation,and independent sample t-test was used for comparison between groups.M(Q1,Q3)was used to describe the non-normal distribution.Single-group comparison before and after treatment adopted matched Mann-Whitney rank,and comparison between groups used the Mann-Whitney rank.Count data was registered as composition ratio and rate with chi-square test used in between groups.Applying binary logistic regression model to analyze the factors affect the pressure.ROC(receive operating characteristic)area under the curve was represented the predictive value of the influencing factors on blood pressure control.The test level was statistically significant at P < 0.05.Results: 1.Basic information of the selected objects The study selected 400 patients with hypertension.The group of nitrendipine combined with hydrochlorothiazide contained 200 registers,excluding 21 patients who didn't completed follow-up visits,or quit to take the medicine without permission(2 patients occurred untoward effect including flushed face,nausea and emesis),and 179 subjects finally,and the lost rate was 10.50%.It was 57(50,63)years old,including 77 males(43.00%)and 102 females(57.00%).Nitrendipine combined with betaloc also had 200 patients,with 18 subjects excluded for the missing visits or self-withdrawal,leaving 182 finally,and the lost rate was 9.00%.It was 56(49,63)years old,including 75 males(41.20%),107 females(58.80%).There was no statistic difference in compliance.Nitrendipine combined with hydrochlorothiazide had higher uric acid than that of plus betaloc.There were no difference in age,sex,baseline blood pressure,body mass index(BMI),plasma glucose,blood lipids,and risk factor aggregation.2.Comparison of visit-to-visit blood pressure variability After 6 months? follow-up and treatment,the visit-to-visit systolic standard deviation(SSD)of nitrendipine combined hydrochlorothiazide was(7.63±4.52)mm Hg,systolic variable coefficient(SCV)was(5.49±3.12)%.In the nitrendipine combined with betaloc,the SSD and SCV was(7.94±4.66)mm Hg and(5.72±3.18)% respectively.There were no significant difference in visit-to-visit blood pressure variability.3.Comparison between the two scheme in effect,the target rate and the total efficiency.3.1 Comparison of treatment effect between the groups By the 6th month of follow-up,the systolic blood pressure observed in nitrendipine plus hydrochlorothiazide was(131.52±7.83)mm Hg,and diastolic blood pressure was(82.96±5.26)mm Hg.In the group of nitrendipine plus betaloc,the systolic and diastolic blood pressure were(130.99±7.83)mm Hg and(83.63±4.75)mm Hg respectively.After treatment,the blood pressure of both groups were significantly lower than before(P?0.05).There were no statistically difference in systolic and diastolic blood pressure.3.2 Comparison of total effective rate and target rate of two groups After the 6th month of treatment,160 patients in nitrendipine combined with hydrochlorothiazide achieved effective,and the total effective rate was 89.40%,79 patients of which were not up to standard.The control rate was 55.87%.Nitrendipine combined with betaloc was effective in 161 subjects,with total effective rate of 88.50%.83 patients didn't achieve the goal.The target rate was 54.40%.There were no statistically significant difference between the groups in the total efficiency and control rate.4.General information in controlled and uncontrolled groups Among the 361 eligible subjects,199 were up to standard and 162 did not,named target group and unmet group.The plasma glucose,total cholesterol(TC)?uric acid?prevalence of hypertension among first-degree relatives and smoking rate in unmet group were significantly higher than that of controlled group(P<0.05).5.Binary Logistic Regression model to analyze the hazards about uncontrolled blood pressure.With the uncontrolled blood pressure as the dependent value,gender?age?plasma glucose?BMI?total cholesterol?triglyceride?baseline systolic and diastolic pressure?smoking?first-degree relatives with hypertension?uric acid was included in the regression model.The result indicated that the total cholesterol OR=1.432(95%CI 1.120-1.831)(P < 0.05)? diabetes mellitus OR=3.193(95%CI 1.181—8.635)(P<0.05)?first-degree relatives with hypertension OR=1.689(95%CI 1.034-2.757)(P<0.05)?baseline systolic pressure OR=1.020(95%CI 1.001-1.039)(P<0.05)were the risk factors for unmet blood pressure.6.The AUC and Cut-off of total cholesterol baseline and systolic blood pressure for uncontrolled hypertension TC showed predictive value for unmet blood pressure(AUC=0.651)(P<0.05),the cut-off was 5.165mmol/l.However,baseline blood pressure had no predictive value(AUC=0.541)(P>0.05).Conclusion: 1?After 6 months of treatment,there was no difference in the visit-to-visit variability between two low-priced antihypertensive groups(nitrendipine combined with hydrochlorothiazide or betaloc).2?There were no statistic difference in compliance.After 6 months of treatment,both of nitrendipine combined with hydrochlorothiazide or betaloc could significantly lower the blood pressure,and total effective rate and control rate had no statistic difference.3?Elevated TC?higher baseline blood pressure ?first-degree relatives have hypertension?diabetes were the risk factors for unmet blood pressure,and the TC could predict the blood pressure up to standard or not.When TC?5.2mmol/l,another medicine was recommend starting use of the scheme. |
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