進階搜尋


   電子論文尚未授權公開,紙本請查館藏目錄
(※如查詢不到或館藏狀況顯示「閉架不公開」,表示該本論文不在書庫,無法取用。)
系統識別號 U0026-2308201112001300
論文名稱(中文) 使用Statin及降血壓藥物治療對於高血壓患者與心、腦血管疾病初級預防之相關性探討
論文名稱(英文) The impact of statin use in primary prevention of cardiovascular and cerebrovascular disease in patients treated with antihypertensive regimens
校院名稱 成功大學
系所名稱(中) 環境醫學研究所
系所名稱(英) Institute of Environmental and Occupational Health
學年度 99
學期 2
出版年 100
研究生(中文) 魯明蓁
研究生(英文) Ming-Chen Lu
學號 s7697409
學位類別 碩士
語文別 中文
論文頁數 84頁
口試委員 指導教授-張志欽
口試委員-吳晉祥
口試委員-郭炤裕
中文關鍵字 高血壓  降血壓用藥  他汀類藥物  藥物順服度  心血管疾病  腦血管疾病 
英文關鍵字 Hypertension  Antihypertensive drugs  Statin  Medication adherence  Cardiovascular disease  Cerebrovascular disease 
學科別分類
中文摘要 在台灣高血壓性疾病為國人十大死因之一,與高血壓有關的心血管及腦血管疾病亦為國人十大死因第二及第三名。當血壓控制較差時,易導致心臟病、心衰竭及中風等疾病發生;且在臨床試驗發現降血壓藥物的治療能有效地降低心、腦血管疾病之發生風險,但降低血壓卻未能完全地預防高血壓併發症的發生。於相關研究中指出,Statin類的降血脂藥物可改善血管內皮細胞功能,減少心血管疾病及中風的風險,並可顯著降低高血壓及糖尿病患者的冠狀動脈心臟病及中風的發生;然而,同時使用Statin類藥物與降血壓藥物治療,是否能有效地預防心血管及腦血管疾病,則有必要作相關研究探討。本研究的目的欲探討於高血壓藥物治療上,合併使用Statin及降血壓藥物治療與心、腦血管疾病初級預防之相關性。本研究為一回溯性世代研究,使用1998-2008年全民健保資料庫之2000年百萬抽樣歸人檔,研究對象為本態性高血壓新診斷的患者,計有73,561位個案納入研究,並分析其醫療保健及用藥資料。統計方法上利用Cox regression模式分析,於模型中將研究個案的降血壓藥物、Statin及Aspirin藥物使用暴露情形視為時間依賴變項放入統計模型中分析,以探討藥物治療與心、腦血管疾病發生風險之相關性。研究結果顯示,研究個案之男女性別比例分別為50.73%及49.27%,年齡層分布上以36-64歲最多,高血壓病史達五年以上者約占35.49%。在研究個案之降血壓藥物治療上,以單一藥物治療占52.25%,其次為兩種藥物治療約24.34%。多變項分析結果,男性比女性,於心血管及腦血管疾病危險比均顯著增加且達顯著差異;當年齡增加疾病風險亦隨之增加;於降血壓藥物治療上,使用兩種或三種以上的藥物比單一藥物治療,其心血管疾病的危險性均顯著增加,達統計上顯著差異(p<0.0001),而在腦血管疾病的風險估計上,使用三種以上藥物比單一藥物治療危險性較高;合併Statin類藥物使用比未使用此藥物相比,可降低缺血性心臟病的發生風險(HR=0.720,95% CI=0.608-0.853,p=0.0001),對於腦血管疾病,可降低缺血性中風風險(HR=0.866,95% CI=0.699-1.073,p=0.1887),卻會增加出血性中風風險(HR=1.778,95% CI=0.998-3.167,p=0.0509),但均未達統計上顯著差異。此外,研究結果亦指出,藥物順服度較差會增加外傷及交通意外的發生風險;進一步探討Aspirin藥物治療與腦血管疾病的影響發現,Aspirin藥物的使用會導致出血性中風風險增加,但未達顯著相關(HR=1.127,95% CI=0.824-1.541,p=0.4550)。本研究結果顯示合併Statin類藥物及降血壓藥物治療,可顯著降低缺血性心臟病的發生風險,雖有降低缺血性中風,增加出血性中風的發生風險的趨勢,但未達到統計上顯著相關。
英文摘要 Hypertension is the leading causes of death in Taiwan. Hypertension related cerebro- and cardio-vascular diseases adverse diseases represent the second and third respectively, cause of death. Poor blood pressure control often leads to the development of adverse outcomes. Studies have shown that antihypertensive medication can effectively reduce the risk of adverse cardio- and cerebro-vascular diseases. However, blood pressure reduction cannot fully prevent the occurrence of adverse outcomes. Moreover, statins have been shown to improve the endothelial cell function and reduce the risk of cardiovascular disease and stroke, and have been shown to significantly reduce the risk of coronary heart disease and stroke in patients with hypertension and diabetes. Whether the use of statins, together with antihypertensive drugs, may offer additional benefit in preventing the cardiovascular and cerebrovascular disease requires further investigate. The aim of this study was to investigate the impact of statin use in primary prevention of cardio- and cerebro-vascular diseases in patients treated with antihypertensive regimens. A retrospective cohort study, from 1998 to 2008, was undertaken. We included hypertensive patients who were newly diagnosed as essential hypertension with ICD-9-CM codes “401-4019”. Information on medication and prescription were retrieved for analysis. In Cox regression model, antihypertensive medication, statin and aspirin exposure were applied as a time-dependent variable to explore the effect of statin use, together with antihypertensive regimens, on the occurrence of adverse outcomes. A total of 73,561 patients were identified as newly diagnosed essential hypertension. Among them, 37,316(50.73%) were male and about 65.06% are 36-64 years old. Of which, 26,107(35.49%) of the patients had hypertension history of ≥5 years. 52.25% of the patients received monotherapy, and 24.34% of them were with dual therapy. In the cox regression analysis, sex, age and Tri+ therpay were associated with cardiovascular and cerebrovascular disease (p<0.0001). Concomitant statin use was associated with the reduction of ischemic heart disease risk (HR=0.720,95% CI =0.608-0.853,p=0.0001) and ischemic stroke (HR=0.866,95% CI =0.699-1.073,p=0.1887), but the increase of hemorrhagic stroke (HR=1.778,95% CI =0.998-3.167,p=0.0509). Poor medication adherence was associated with the increased traumatic accident and traffic accident. Aspirin use caused the non-significant increase of hemorrhagic stroke (HR=1.127,95% CI =0.824-1.541,p=0.4550). Our study results demonstrate that concomitant statin use is associated with the decreased of ischemic heart disease, but the increase of hemorrhagic stroke.
論文目次 中文摘要 i
Abstract iii
誌 謝 v
目 錄 vi
表目錄 ix
圖目錄 x
第一章 研究背景 1
第二章 文獻回顧與探討 4
第一節 高血壓之通論 4
2.1.1 高血壓之分類 4
2.1.2 高血壓之定義標準 4
第二節 高血壓之流行病學 6
第三節 高血壓自知率、治療及控制 9
第四節 高血壓與心、腦血管疾病之關係 12
第五節 高血壓用藥及治療 14
2.5.1 降血壓藥物種類 14
2.5.2 高血壓治療目標與流程 15
2.5.3 降血壓藥物治療 18
2.5.4 降血壓藥物與statin降血脂藥物治療 20
2.5.5 藥物順服度 21
第三章 研究目的 22
第四章 研究方法 23
第一節 研究設計 23
4.1.1 研究類型 23
4.1.2 研究材料及工具 23
4.1.3 研究工具 25
4.1.4 研究對象之選取 26
4.1.5 研究對象排除標準 28
第二節 研究變項及操作定義 29
4.2.1 自變項操作型定義 29
4.2.2 依變項操作型定義 31
4.2.3 研究藥品定義 32
第三節 研究流程與檔案串聯 33
4.3.1 研究流程 33
4.3.2 檔案串聯 34
第四節 統計分析方法及工具 35
4.4.1 描述性統計 35
4.4.2 推論性統計 35
4.4.3 統計分析軟體 36
第五章 研究結果 37
第一節 研究個案之基本變項特徵 37
5.1.1 基本變項分布情形 37
5.1.2 藥物治療使用分布情形 37
5.1.3 不良健康效應分布情形 38
第二節 不同醫事機構與降血壓藥物逐年使用分布情形 39
5.2.1 各醫事機構降血壓藥物使用分布情形 39
5.2.2 醫學中心降血壓藥物逐年使用分布情形 39
5.2.3 區域醫院降血壓藥物逐年使用分布情形 40
5.2.4 地區醫院降血壓藥物逐年使用分布情形 40
5.2.5 基層院所降血壓藥物逐年使用分布情形 41
第三節 醫事機構與他汀類降血脂之分布情形 42
第四節 心血管疾病逐年發生情形 43
第五節 各因子與疾病住院危險比 44
5.5.1 心血管疾病住院風險 44
5.5.2 缺血性心臟病住院風險 45
5.5.3 腦血管疾病住院風險 46
5.5.4 缺血性中風住院風險 48
5.5.5 出血性中風住院風險 49
第六節 藥物順服度之健康效應 51
5.6.1 藥物順服度與外傷事故危險比 51
5.6.2 藥物順服度與交通意外危險比 51
第六章 研究討論 52
第七章 結論與建議 56
參考文獻 57
附錄、圖 69
附錄、表 73
參考文獻 [Anonymous]. 1991. Swedish Aspirin Low-Dose Trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. The SALT Collaborative Group. Lancet 338(8779): 1345-1349.
[Anonymous]. 1997. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 157(21): 2413-2446.
[Anonymous]. 2002. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360(9326): 7-22.
[Anonymous]. 2005. Racial/ethnic disparities in prevalence, treatment, and control of hypertension--United States, 1999-2002. MMWR Morb Mortal Wkly Rep 54(1): 7-9.
[Anonymous]. Guidelines commottee. 2003. European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 21(6): 1011-1053.
Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. 2005. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 366(9493): 1267-1278.
Black HR, Elliott WJ, Grandits G, Grambsch P, Lucente T, White WB, et al. 2003. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. Jama 289(16): 2073-2082.
Bradley HA, Wiysonge CS, Volmink JA, Mayosi BM, Opie LH. 2006. How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analysis. J Hypertens 24(11): 2131-2141.
Brookhart MA, Patrick AR, Shrank WH, Dormuth CR. 2010. Validating studies of adherence through the use of control outcomes and exposures. Am J Hypertens 23(2): 110.
Brunner HR. 2001. Experimental and clinical evidence that angiotensin II is an independent risk factor for cardiovascular disease. Am J Cardiol 87(8A): 3C-9C.
Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton P, et al. 1995. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension 26(1): 60-69.
Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, et al. 2004. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 350(15): 1495-1504.
Carretero OA, Oparil S. 2000. Essential hypertension. Part I: definition and etiology. Circulation 101(3): 329-335.
Chapman RH, Yeaw J, Roberts CS. 2010. Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees. BMC Cardiovasc Disord 10: 29.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. 2003. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama 289(19): 2560-2572.
Cohn JN, Tognoni G. 2001. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 345(23): 1667-1675.
Collins R, MacMahon S. 1994. Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 50(2): 272-298.
Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH, et al. 2002. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens (Greenwich) 4(6): 393-404.
Dahlof B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, et al. 2002. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359(9311): 995-1003.
Damasceno A, Azevedo A, Silva-Matos C, Prista A, Diogo D, Lunet N. 2009. Hypertension prevalence, awareness, treatment, and control in mozambique: urban/rural gap during epidemiological transition. Hypertension 54(1): 77-83.
Ebrahim S. 1998. Detection, adherence and control of hypertension for the prevention of stroke: a systematic review. Health Technol Assess 2(11): i-iv, 1-78.
Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. 2004. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension 44(4): 398-404.
Gatchev O, Rastam L, Lindberg G, Gullberg B, Eklund GA, Isacsson SO. 1993. Subarachnoid hemorrhage, cerebral hemorrhage, and serum cholesterol concentration in men and women. Annals of epidemiology 3(4): 403-409.
Gorelick PB, Weisman SM. 2005. Risk of hemorrhagic stroke with aspirin use: an update. Stroke; a journal of cerebral circulation 36(8): 1801-1807.
Hajjar I, Kotchen JM, Kotchen TA. 2006. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health 27: 465-490.
Hajjar I, Kotchen TA. 2003. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. Jama 290(2): 199-206.
Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. 1998. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351(9118): 1755-1762.
He J, Whelton PK, Vu B, Klag MJ. 1998. Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA : the journal of the American Medical Association 280(22): 1930-1935.
Hebert PR, Gaziano JM, Chan KS, Hennekens CH. 1997. Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. Jama 278(4): 313-321.
Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, et al. 2006. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med 166(17): 1836-1841.
Iribarren C, Jacobs DR, Sadler M, Claxton AJ, Sidney S. 1996. Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program. Stroke; a journal of cerebral circulation 27(11): 1993-1998.
Iribarren C, Reed DM, Burchfiel CM, Dwyer JH. 1995. Serum total cholesterol and mortality. Confounding factors and risk modification in Japanese-American men. JAMA : the journal of the American Medical Association 273(24): 1926-1932.
Jackevicius CA, Mamdani M, Tu JV. 2002. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. Jama 288(4): 462-467.
Kannel WB. 2000. Risk stratification in hypertension: new insights from the Framingham Study. Am J Hypertens 13(1 Pt 2): 3S-10S.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. 2005. Global burden of hypertension: analysis of worldwide data. Lancet 365(9455): 217-223.
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. 2004. Worldwide prevalence of hypertension: a systematic review. J Hypertens 22(1): 11-19.
Kettani FZ, Dragomir A, Cote R, Roy L, Berard A, Blais L, et al. 2009. Impact of a better adherence to antihypertensive agents on cerebrovascular disease for primary prevention. Stroke 40(1): 213-220.
Kim S, Iwao H. 2000. Molecular and cellular mechanisms of angiotensin II-mediated cardiovascular and renal diseases. Pharmacol Rev 52(1): 11-34.
Konishi M, Iso H, Komachi Y, Iida M, Shimamoto T, Jacobs DR, Jr., et al. 1993. Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries. The Akita Pathology Study. Stroke; a journal of cerebral circulation 24(7): 954-964.
LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, et al. 2005. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 352(14): 1425-1435.
LaRosa JC, He J, Vupputuri S. 1999. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. Jama 282(24): 2340-2346.
Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP. 1999. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke; a journal of cerebral circulation 30(12): 2535-2540.
Levenson JW, Skerrett PJ, Gaziano JM. 2002. Reducing the global burden of cardiovascular disease: the role of risk factors. Prev Cardiol 5(4): 188-199.
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. 1996. The progression from hypertension to congestive heart failure. Jama 275(20): 1557-1562.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. 2002. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360(9349): 1903-1913.
Lloyd-Jones DM, Evans JC, Larson MG, O'Donnell CJ, Roccella EJ, Levy D. 2000. Differential control of systolic and diastolic blood pressure : factors associated with lack of blood pressure control in the community. Hypertension 36(4): 594-599.
Mamo JC, Wheeler JR. 1994. Chylomicrons or their remnants penetrate rabbit thoracic aorta as efficiently as do smaller macromolecules, including low-density lipoprotein, high-density lipoprotein, and albumin. Coronary artery disease 5(8): 695-705.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25(6): 1105-1187.
Materson BJ, Reda DJ, Cushman WC, Massie BM, Freis ED, Kochar MS, et al. 1993. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. N Engl J Med 328(13): 914-921.
Mathers CD, Loncar D. 2006. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3(11): e442.
Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, et al. 2009. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation 120(16): 1598-1605.
Mochizuki S, Dahlof B, Shimizu M, Ikewaki K, Yoshikawa M, Taniguchi I, et al. 2007. Valsartan in a Japanese population with hypertension and other cardiovascular disease (Jikei Heart Study): a randomised, open-label, blinded endpoint morbidity-mortality study. Lancet 369(9571): 1431-1439.
Murray CJ, Lopez AD. 1997. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 349(9061): 1269-1276.
Neal B, MacMahon S, Chapman N. 2000. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 356(9246): 1955-1964.
Neaton JD, Wentworth D. 1992. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Archives of internal medicine 152(1): 56-64.
Nickenig G. 2004. Should angiotensin II receptor blockers and statins be combined? Circulation 110(8): 1013-1020.
Noda H, Iso H, Irie F, Sairenchi T, Ohtaka E, Doi M, et al. 2009. Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study. Circulation 119(16): 2136-2145.
Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. 2007. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension 49(1): 69-75.
Pedersen TR, Faergeman O, Kastelein JJ, Olsson AG, Tikkanen MJ, Holme I, et al. 2005. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. Jama 294(19): 2437-2445.
Penning-van Beest FJ, Termorshuizen F, Goettsch WG, Klungel OH, Kastelein JJ, Herings RM. 2007. Adherence to evidence-based statin guidelines reduces the risk of hospitalizations for acute myocardial infarction by 40%: a cohort study. Eur Heart J 28(2): 154-159.
Perreault S, Dragomir A, Blais L, Berard A, Lalonde L, White M. 2008. Impact of adherence to statins on chronic heart failure in primary prevention. Br J Clin Pharmacol 66(5): 706-716.
Perreault S, Dragomir A, Blais L, Berard A, Lalonde L, White M, et al. 2009a. Impact of better adherence to statin agents in the primary prevention of coronary artery disease. Eur J Clin Pharmacol 65(10): 1013-1024.
Perreault S, Dragomir A, Roy L, White M, Blais L, Lalonde L, et al. 2010. Adherence level of antihypertensive agents in coronary artery disease. Br J Clin Pharmacol 69(1): 74-84.
Perreault S, Ellia L, Dragomir A, Cote R, Blais L, Berard A, et al. 2009b. Effect of statin adherence on cerebrovascular disease in primary prevention. Am J Med 122(7): 647-655.
Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, et al. 2003a. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 349(20): 1893-1906.
Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, et al. 2003b. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 362(9386): 759-766.
Pignone M, Phillips C, Mulrow C. 2000. Use of lipid lowering drugs for primary prevention of coronary heart disease: meta-analysis of randomised trials. Bmj 321(7267): 983-986.
Psaty BM, Furberg CD, Kuller LH, Cushman M, Savage PJ, Levine D, et al. 2001. Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: the cardiovascular health study. Arch Intern Med 161(9): 1183-1192.
Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, et al. 2003. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 289(19): 2534-2544.
Psaty BM, Manolio TA, Smith NL, Heckbert SR, Gottdiener JS, Burke GL, et al. 2002. Time trends in high blood pressure control and the use of antihypertensive medications in older adults: the Cardiovascular Health Study. Arch Intern Med 162(20): 2325-2332.
Schnohr P, Jensen JS, Scharling H, Nordestgaard BG. 2002. Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12 000 men and women from The Copenhagen City Heart Study. Eur Heart J 23(8): 620-626.
Sever PS, Dahlof B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al. 2003. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 361(9364): 1149-1158.
Sharma AM, Wittchen HU, Kirch W, Pittrow D, Ritz E, Goke B, et al. 2004. High prevalence and poor control of hypertension in primary care: cross-sectional study. J Hypertens 22(3): 479-486.
Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al. 1995. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 333(20): 1301-1307.
Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, et al. 2006. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 333(7557): 15.
Singh RB, Suh IL, Singh VP, Chaithiraphan S, Laothavorn P, Sy RG, et al. 2000. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention. J Hum Hypertens 14(10-11): 749-763.
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. 2005. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care 43(6): 521-530.
Sowers JR, Epstein M, Frohlich ED. 2001. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension 37(4): 1053-1059.
Staessen JA, Wang JG, Thijs L. 2001. Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet 358(9290): 1305-1315.
Stokes J, 3rd, Kannel WB, Wolf PA, D'Agostino RB, Cupples LA. 1989. Blood pressure as a risk factor for cardiovascular disease. The Framingham Study--30 years of follow-up. Hypertension 13(5 Suppl): I13-18.
Su TC, Bai CH, Chang HY, You SL, Chien KL, Chen MF, et al. 2008. Evidence for improved control of hypertension in Taiwan: 1993-2002. J Hypertens 26(3): 600-606.
Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, et al. 2006. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 113(6): e85-151.
Turnbull F. 2003. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362(9395): 1527-1535.
Verdecchia P, Reboldi G, Angeli F, Gattobigio R, Bentivoglio M, Thijs L, et al. 2005. Angiotensin-converting enzyme inhibitors and calcium channel blockers for coronary heart disease and stroke prevention. Hypertension 46(2): 386-392.
Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al. 2002. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. Jama 288(15): 1882-1888.
WHO. 2011 Cardiovascular diseases(CVDs). Fac sheet number 317. Update January 2011 . http://www.who.int/mediacentre/factsheets/fs317/en/index.html.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, et al. 2003. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. Jama 289(18): 2363-2369.
Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, et al. 2004. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 43(1): 10-17.
Wu PH, Yang CY, Yao ZL, Lin WZ, Wu LW, Chang CC. 2010. Relationship of blood pressure control and hospitalization risk to medication adherence among patients with hypertension in Taiwan. Am J Hypertens 23(2): 155-160.
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. 2000. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342(3): 145-153.
陳建仁等. 2003. 台灣地區高血壓、高血糖、高血脂盛行率調查報告。行政院衛生署國民健康局.
陳建仁等. 2008. 台灣地區高血壓、高血糖、高血脂追蹤調查報告。行政院衛生署國民健康局委辦.
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2016-09-02起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw