摘要
目的:了解城市和农村社区卫生服务机构管理的高血压患者药物治疗特点和血压控制情况。方法:本研究为横断面调查,从山东省青岛市、乳山县、沂源县以及江苏省无锡市、涟水县、射阳县分别选取3个社区卫生服务中心,每个省按照城市和农村患者等比例从居民健康档案中随机抽取750例高血压患者。结果:高血压患者未服药治疗、服用一种降压药、两种以上药物联合以及复方药物应用率城市分别为:24.0%、47.7%、13.8%、9.5%,农村分别为:36.7%、29.5%、6.4%、25.4%,城市和农村高血压患者治疗特点差异有统计学意义(χ~2=138.859,P<0.001)。伴有缺血性心血管病的高血压患者未服药治疗的比例低于没有缺血性心血管疾病的患者,联合用药治疗的比例高于没有缺血性心血管疾病的患者(χ~2=32.061,P<0.001);应用率在前两位的降压药物城市分别为钙离子拮抗剂(59.2%)和ARB/ACEI(30.4%),农村分别为复方制剂(40.1%)和钙离子拮抗剂(30.1%)。患者两周服药率城市为76.0%,农村为63.6%,多因素Logistic回归分析显示,随访和家庭自测血压可提高药物治疗依从性,相对危险度分别为2.315(95%CI:1.830~2.927)和2.444(95%CI:1.801~3.317)。两种药物联合应用者血压控制率为48.9%,高于单一用药和复方药物治疗的患者(χ~2=8.503,P=0.037)。结论:城市社区高血压患者药物治疗率高于农村,社区随访和家庭血压监测可以改善高血压患者的药物治疗依从性;两种以上药物治疗者血压控制率较高,但城市和农村应用率均处于低水平,联合药物应用比例和降压效果还需要提升。
Objective： To understand the characteristics of antihypertensive therapy and blood pressure control in patients with hypertension from part of urban and rural community health service. Methods： His pilot cross-sectional investigation was conducted between October 2014 and November 2014. Two cities（ Qingdao city,Wuxi city） and four townships（ Rushan,Yiyuan,Lianshui,and Sheyang） located in Shandong and Jiangsu province was selected. 751 urban patients and 760 rural patients were recruited and asked to respond to an interviewer-led questionnaire. Results： The percentage of without medication,taking an antihypertensive drug,taking two or more drugs and compound anti-hypertensive drugs was 24. 0% 、47. 7% 、13. 8% 、9. 5% respectively in urban subjects and 36. 7% 、29. 5% 、6. 4% 、25. 4% respectively in rural subjects,it was significantly different between urban and rural（ χ^2= 138. 859,P〈0. 001）. The proportion of taking two or more antihypertensive drugs was higher in patient with ischemic cardiovascular disease than that in patients without ischemic cardiovascular disease（ χ^2= 32. 061,P〈0. 001）; The most commonly prescribed agents in urban subjects was Calcium antagonists（ 59. 2%） and ARB/ACEI（ 30. 4%）, and it was compound anti-hypertensive tablets（ 40. 1%） and Calcium antagonists（ 30. 1%） in rural subjects. The treatment rate within two weeks was 76. 0% and 63. 6% respectively in urban and rural subjects. multivariate logistic regression analysis showed followup and home blood pressure monitoring could improve the treatment compliance,the odds ration was 2. 315（ 95% CI： 1. 830-2. 927） and 2. 444（ 95% CI： 1. 801-3. 317）.The control rate of blood pressure among patients taking two or more drugs was 38. 8%,it was likely higher than that in other subjects（ χ^2= 8. 503,P = 0. 037）.Conclusion： The rate of antihypertensive therapy was higher in urban subjects than that in rural subjects. follow-up and home blood pressure monitoring could improve the treatment compliance. two or more drugs combined helped to improve control rate of blood pressure,but it was quite low in both urban and rural patient,the percentage and the effect of two or more drugs combined should be increased.
作者
苏江莲
左惠娟
陈晓荣
王锦纹
马吉祥
SU Jianglian;ZUO Huijuan;CHEN Xiaorong;WANG Jinwen;MA Jixiang(Department of Research Community Health and Prevention,Beifing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart,Lung and Blood Vessel Diseases, Beijing 100029, China)
出处
《心肺血管病杂志》
2018年第6期491-495,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
美国疾病预防与控制中心资助项目(5 U19 GH 000636)
关键词
高血压
药物治疗
血压控制
依从性
Hypertension
Medication
Blood pressure control
Compliance
作者简介
通信作者：马吉祥，博士，中国疾控中心慢病中心主任，从事慢性病的预防与控制。E-mail：majix@163．com
