Hypertension is a major risk factor for cardiovascular disease. Antihypertensive drug therapy should not only consider the characteristics of the patient's blood pressure but also the patient's comorbid conditions. Currently, there is a lack of research on the medication status and influencing factors of hypertensive patients based on family doctor services.
To investigate the current medication status of hypertensive patients who purchased family doctor contract services in Jieshou City, Anhui Province, to describe the association between patient medication behavior and patient characteristics, to explore the influencing factors of medication adjustment, and to analyze the rationality of medication use in primary hypertensive patients.
Using cluster sampling, from July to August 2021, 48 administrative villages were randomly selected from Jieshou City, Anhui. Data on patient characteristics and medication were collected through face-to-face interviews using a self-made questionnaire. According to the "National Guidelines for the Prevention and Management of Hypertension at the Primary Level (2020 Edition) ", the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categories: category A includes angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), category B includes beta-blockers, category C includes calcium channel blockers (CCBs), category D includes diuretics, and category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of iFLYTEK's intelligent voice blood pressure monitor to analyze the medication behavior of patients with different characteristics. Multivariate Logistic regression analysis was used to explore the influencing factors of medication adjustment in hypertensive patients. In this study, "combination medication" refers to taking a combination drug or two or more antihypertensive drugs, and "medication adjustment" refers to patients previously taking other antihypertensive drugs.
A total of 3, 005 hypertensive patients were included in this study, including 1 291 males (43.0%) and 1 714 females (57.0%), with an average age of (65.5±9.8) years. The medication rate of hypertension was 79.1%, and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugs, the rates of different types of antihypertensive drugs from high to low were (some patients had combination medication) : category E (39.6%), category C (35.1%), category D (20.3%), category A (20.1%), and category B (3.7%) ; the most frequently taken antihypertensive drug was compound lisinopril (33.7%). For patients with an average annual blood pressure ≥160/100 mmHg, 12.2% and 4.9% still did not take antihypertensive drugs. Patients' combination medication mainly involved category E antihypertensive drugs. For patients with an average annual "diastolic pressure≥100 mmHg" and "with complications", the rates of adjusted category A and C antihypertensive drugs increased relatively more; for patients with an average annual "systolic pressure ≥160 mmHg" and "without complications", the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medication (OR=1.042, 95%CI=1.031-1.053, P<0.001), education level above junior high school (OR=1.488, 95%CI=1.195-1.853, P<0.001), combined hyperlipidemia (OR=1.267, 95%CI=1.052-1.525, P=0.013), combined cardiovascular diseases (OR=1.394, 95%CI=1.166-1.667, P<0.001), and combined cerebrovascular diseases (OR=1.258, 95%CI=1.040-1.522, P=0.018) were promoting factors for medication adjustment in patients, while advanced age (OR=0.980, 95%CI=0.971-0.990, P<0.001) was an inhibiting factor for medication adjustment.
The medication rate among rural hypertensive patients in Jieshou City is high, mainly involving category E and C antihypertensive drugs. Longer duration of medication, education level above junior high school, combined hyperlipidemia, combined cardiovascular and cerebrovascular diseases are promoting factors for medication adjustment in patients, while advanced age is an inhibiting factor for medication adjustment.
The dual antiplatelet therapy of aspirin combined with ticagrelor is the preferred antiplatelet therapy for patients with ST segment elevation myocardial infarction (STEMI) who receive primary percutaneous coronary intervention (PPCI). Compared with clopidogrel, ticagrelor can inhibit platelets faster and more effectively, and improve prognosis. However, there is still a lack of research on the application of reduced dose ticagrelor in STEMI patients receiving PPCI treatment.
To compare the different doses of ticagrelor on the efficacy and safety in patients with STEMI based on propensity score matching (PSM) .
The patients with STEMI who underwent PPCI and antiplatelet therapy with ticagrelor at the Fifth Department of Cardiology, Second Hospital of Hebei Medical University from June 2019 to May 2021 were selected consecutively. According to the different maintenance doses of ticagrelor, patients were divided into a reduced dose group (n=60) and a standard group (n=180), using ticagrelor 60 mg/time (2 times/day) and 90 mg/time (2 times/day), respectively. The PSM method was used to perform a 1∶1 match between two groups, with matching variables including gender, age, medical history, Killip grade at admission, and intervention related parameters. Finally, 54 patients were included in the each group. Follow-up was conducted on both groups at 1 month, 3 months, and 6 months after discharge, and platelet parameters as well as clinical events were recorded and compared between the two groups of patients.
There was no statistically significant difference in baseline data, intervention parameters, and incidence of major adverse cardiovascular events (MACEs) during hospitalization between the two groups of patients after PSM (P>0.05). At baseline, there was no statistically significant difference in platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW) between the two groups (P>0.05). The level of platelet aggregation rate (PAR) of patients in the reduced dose group was lower than that of the standard group (P<0.05). At discharge, the MPV of patients in the reduced dose group was higher than that in the standard group, and the PDW was lower than that in the standard group (P<0.05). At one month after discharge, there was no statistically significant difference in PLT, MPV, PDW, and PAR between the two groups (P>0.05). At 3 months after discharge, the PDW of patients in the reduced dose group was higher than that of the standard group (P<0.05). At 6 months after discharge, the MPV of patients in the reduced dose group was higher than that of the standard group (P<0.05). There was no statistically significant difference in PLT and PAR before and after discharge between patients in the reduced dose group and those in the standard group (P>0.05). Patients in the reduced dose group and standard group had higher MPV than baseline at discharge, lower PDW than baseline at discharge in the reducde dose group, and lower PAR than baseline at discharge in the standard group (P<0.05). The MPV of patients in the reduced dose group at 1, 3, and 6 months after discharge was lower than those at discharge, and the PDW was higher than that at discharge (P<0.05). The PAR of the standard group patients at 1, 3, and 6 months was lower than baseline and higher than that at discharge (P<0.05). There was no statistically significant difference in the incidence of MACEs and severe bleeding events between the two groups during follow-up (P>0.05) .
Reduced dose of ticagrelor treatment is safe and effective for STEMI patients undergoing PPCI.
Factor Ⅺ (FⅪ) plays a major role in thrombus amplification and an ancillary role in hemostasis. This differential contribution is expected to provide new ideas for the prevention and treatment of thrombotic diseases by targeting FⅪ as a potentially safer anticoagulation strategy. Currently, an increasing number of FⅪ inhibitors are entering phaseⅢ clinical trials, and although these inhibitors showed promising clinical potential, the strategies for monitoring and reversing the effects of these inhibitors remain unclear, which poses new challenges for laboratory monitoring and clinical practice. This review, based on the physiological function of FⅪ and FⅪ inhibitors under study, systematically explored the laboratory evidence of coagulation activity linked to these inhibitors, summarized potential methods of reversal in combination with the treatment protocols of inherited FⅪ deficiency, which provided certain references for the development of clinical treatment protocols and reversal strategies.