社区人群高血压综合防治10年随访研究

目的 :探讨降低社区人群高血压患病率和脑卒中及心血管事件发生率的途径。方法 :对该社区 2 5岁以上居民共计 2 1336人进行高血压防治教育 ,10年来 ,通过改变不良生活习惯 ,定期监测血压、血糖及血脂等项目 ;并采取普治与专科治疗相结合的方法。观察防治前后高血压知晓率、患病率、治疗率、控制率及脑卒中与心血管事件年发生率、致残率和死亡率。结果 :10年间该社区人群高血压的知晓率、治疗率及控制率分别由防治前的 2 1.8%、13.3%及 4 .4 %提高到 91.8%、89.3%及 73.2 % ;脑卒中与心血管事件年发生率、年致残率和年死亡率分别由防治前的 2 .0 1‰、1.5 2‰及 1.10‰降至 1.4 1‰、1.2 3‰及 0 .4 7‰。各项指标比较 ,差异均有非常显著性意义 (均P <0 .0 1)。结论 :提高知晓率是降低社区人群高血压患病率的基础与重点 ,普治与专科治疗相结合是降低脑卒中及心血管事件发生率的关键     

义乌市北苑社区高血压综合干预信息化管理效果评价

目的评价社区高血压综合干预信息化管理的初步效果。方法按照《浙江省高血压社区综合干预信息化管理规范》要求,对高血压患者实施非药物干预和药物干预,并利用"U1000系统"对全人群进行信息化管理,对综合干预结果进行统计学分析。结果实施高血压社区综合干预信息化管理规范三年,社区人群管理率达88.13%;社区人群平均血压水平下降,与综合干预前比较差异均有统计学意义(P<0.05);急性心脑血管病事件发生率下降,高血压患者知晓率、服药率、控制率提高。结论在社区开展高血压综合干预信息化管理规范工作是完全可行、有效的。     

绍兴市马山镇社区高血压综合干预效果评价

目的探讨高血压社区综合干预的可行性及其效果。方法采用整群抽样方法抽取15岁以上24669人作为研究对象,实行分类管理。一般人群:指血压<140/90mmHg,不伴有任何危险因素者;高危人群,血压在正常高限(120~139/80~89mmHg)伴有心血管病危险因素一项及以上者;高血压人群:指血压≥140/90mmHg,包括原有高血压病史,近两周内仍在服降压药血压正常者。高血压人群根据患者血压水平、心血管病危险因素、靶器官损害及相关疾病的情况分成:1级高血压(轻度)2、级高血压(中度)、3级高血压(重度)。对干预人群进行定期随访:一般人群和高危人群,以健康教育改变不良生活行为方式为主;对患病人群按分级管理原则,采取药物和非药物相结合的综合措施。结果高血压患病率为18.90%;人群随访率为85.68%,健康教育覆盖率92.83%;人群高血压知晓率由28.1%上升到75.7%、治疗率由28.1%上升到70.23%、控制率由8.3%上升到56.4%;人群舒张压平均下降0.93mmHg、收缩压平均上升3.08mmHg;戒烟率为6.76%、戒酒率为5.50%、吸烟量和饮酒量均有所下降、运动量也有所增加。结论《规范》在社区人群中实施不仅是可行的,而且是有效的,但需坚持不懈。     

社区控制技术对浙江省社区高血压人群干预效果的评价分析

目的评价以"规模化、规范化、信息化"为核心的高血压社区控制技术对高血压人群的管理效果。方法 2010年以《中国高血压防治指南》为依据,建立以"规模化、规范化、信息化"为核心的高血压社区控制技术,选择浙江省有代表性的城市、城镇、农村社区高血压人群为研究对象进行大规模社区干预试验。按照高血压社区控制技术制订实施方案,规范化培训干预组医生,按照方案要求对干预组高血压患者进行分级管理。结果截至2013年12月共管理了高血压患者20 807例。其中干预组从基线的8996例增加到12295例,规范管理率达到86.8%;干预组高血压患者平均收缩压和平均舒张压分别下降了11.21 mmHg和8.55 mmHg(均为P<0.05),治疗率和控制率由基线时的55.4%和38.6%提高到86.7%和77.8%(均为P<0.05),心血管危险因素有显著改善(均为P<0.05),急性心血管事件发生呈下降趋势。结论高血压社区控制技术能有效提高社区高血压规范管理率,有效改善社区高血压人群防治效果。     

嘉兴市农村人群高血压综合干预效果评价

目的探索适合农村社区预防和控制高血压的综合防治方案。方法按照浙江省医药卫生科技98A069项目在嘉兴农村分别设立干预区和对照区。在干预区内对一般人群进行健康教育,对高危人群进行强化干预,对高血压人群进行系统管理。结果1、干预区高血压患病率的上升幅度低于对照区(前者为36.22%,后者为104.91%)。25、年内干预区高血压患者收缩压及均值较基线升高了3mmHg,舒张压升高了1.8mmHg;对照组区高血压患者收缩压均值较基线升高了12.3mmHg,舒张压升高了7.4mmHg。3、干预区高危人群各类高危因素下降比例大于对照区。4、高血压患者的治疗率和控制率明显高于基线时的水平。结论农村社区开展高血压综合干预防治不仅有效,而且切实可行。     

二级医院介入社区高血压病长期多因素综合干预研究

目的探讨二级医院在社区高血压防治尤其是高危患者的二期预防方面的作用。方法在太仓市城厢地区把各社区高血压高危患者采取“心血管病人之友”俱乐部方式组织起来，进行了平均近5年的多因素综合干预。结果报告的145例患者血压、体重指数、甘油三酯有明显下降，患者接受干预的依从性高，80．7％的患者血压控制在140／90mmHg以下。31例合并糖尿病患者血糖明显下降，血糖控制率明显提高。每人的平均降压费用仅2．30元／d，6年来未有心血管死亡的发生，心血管事件显著减少。结论二级医院介入社区高血压人群的防治有明显的效果，是一种适合我国国情的心脑血管疾病防治模式。     

加强高血压防治的意义和策略

我国的高血压患病率不断上升而知晓率、治疗率、控制率却处于低水平。中国医疗卫生人员应及时更新高血压防治观念和防治知识。社区综合干预可有效提高高血压的知晓率、治疗率和控制率,并降低脑卒中及心血管事件发生率。     

网络信息化管理对提高基层医师高血压诊治水平及社区高血压防治效果评价

目的评价网络信息化管理对提高基层医师高血压诊治能力以及社区高血压防治效果的作用。方法以《中国高血压防治指南》为依据制定了《高血压社区综合干预信息化管理规范》(简称《规范》),根据此方案建立信息化管理网络。于2007—2010年,对干预组医务人员进行网络跟踪临床指导,对干预组≥35岁居民实施全人群分类及高血压分级管理、综合干预,评价其干预效果。结果干预组运用专家网络跟踪指导模式培训社区医师,3年后高血压知识和病例诊治能力均明显提高,平均总分由47.3提高到78.1(P<0.05);干预组实施高血压社区信息化管理后效果显著(P<0.05):全人群管理率由36.0%提高至63.1%;人群收缩压(SBP)、舒张压(DBP)分别下降5.5 mmHg和1.7 mmHg;一、二、三级高血压管理级别比例变化明显,一级管理的比例由干预前67.2%提高至93.8%,二级、三级管理的比例由干预前19.8%、11.8%下降到5.3%、1.9%;高血压知晓率、治疗率和控制率分别由58.7%、48.5%、33.4%提高到89.7%、77.0%和72.6%;不良生活方式及行为有所改善,人群吸烟率、饮酒率、饮食偏咸以及少运动比例由19.7%、24.3%、23.5%、74.2%下降至14.5%、17.5%、15.5%、34.1%;心脑血管病急性事件发病、死亡率呈下降趋势。与对照组比较有统计学意义(P<0.05)。结论网络信息化管理能有效提高社区医师的诊治能力和社区高血压防治效果。     

嘉兴市洪合镇高血压综合干预管理规范实践与效果分析

目的进一步做好高血压社区综合干预工作,建立一套适合各类社区"规范化、规模化、信息化"的高血压社区综合干预管理模式。方法按照《浙江省高血压社区综合干预信息化管理规范》(简称《规范》)实施方案,嘉兴洪合镇作为农村试点。在试点内采用专门为社区高血压综合干预创建的人群管理系统(gxy.u1000.net),按照信息采集标准,对所辖社区内15岁以上(含15岁)户口在册居民进行基线调查,建立对社区不同人群(健康人群、高危人群、患病人群)综合干预方法,规范社区人群健康趋势的监测系统和综合干预管理模式的效益/效果评估体系。结果1、通过近两年试点工作,目标人群管理率达到75%,高血压检出率16.79%,随访率达85%。2、高危人群各类危险因素有所下降。3、高血压患者的治疗率和控制率高于基线调查时的水平。4、减少了心脑血管病急性事件的发生。结论在农村社区实施高血压综合干预信息化管理不仅可行,而且是有效的。     

秦皇岛铁路地区高血压综合防治模式研究及效果评价

目的探索在秦皇岛铁路地区建立规范化、信息化的高血压社区干预管理模式,进一步做好高血压综合防治工作。方法从2005年起对秦皇岛铁路地区职工每年进行体检和统一问卷调查,围绕高血压的防治目标建立信息化管理网络,实行健康人群、高危人群、患病人群分类及高血压患者分级管理、综合干预,定期进行效果评价。结果经过3 a的综合干预管理,秦皇岛铁路地区职工高血压发病率逐年下降,高血压发病危险因素明显降低,高血压的知晓率、治疗率、控制率较基线水平显著提高,同时减少了心脑血管急性事件的发生。结论实施社区人群高血压综合干预、规范化、信息化管理可行、有效。     

Coronary heart disease in China

Coronary heart disease (CHD) is the second leading cause of cardiovascular death in the Chinese population. It accounts for 22% of cardiovascular deaths in urban areas and 13% in rural areas. Although mortality from CHD in China is relatively low compared with Western levels, the burden of CHD has been increasing. This is partly because of a worsening profile of risk factors, such as an increased prevalence of hypertension, hyperlipidaemia, overweight/obesity, diabetes, etc and partly because of an increase in the aged population. Large-scale, randomised controlled trials on thrombolytic, blood-pressure-lowering, antiplatelet and blood-cholesterol-lowering treatment as well as cardiac intervention have been conducted for Chinese patients with myocardial infarction. The studies provide important information for the prevention and management of chronic CHD and acute myocardial infarction in the Chinese population.     

Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design,methods and initial experience

The Isfahan Healthy Heart Programme (IHHP) is a five to six year comprehensive integrated community-based programme for cardiovascular diseases (CVD) prevention and control via reducing CVD risk factors and improvement of cardiovascular healthy behaviour in a target population. IHHP started late in 1999 and will be finished in 2005-2006. A primary survey was done to collect baseline data from interventional (Isfahan and Najaf-Abad) and reference (Arak) communities. In a two-stage sampling method, we randomly selected 5 to 10 percent of households from randomly selected clusters. Then individuals aged > or = 19 years were selected for the survey. This way, data from 12,600 individuals (6300 in interventional counties and 6300 in the reference county) was collected and stratified according to living area (urban vs. rural) and different age and sex groups. The samples underwent a 30-minute interview to complete validated questionnaires containing questions on demography, socioeconomic status, smoking behaviour, physical activity, nutritional habits and other behaviour regarding CVD. Blood pressure and body mass index (BMI) measurements were done and fasting blood samples were taken for two hours post load plasma glucose (2 hpp), serum (total, HDL and LDL) cholesterol and triglyceride levels. A twelve-lead electrocardiogram was recorded in all persons above 35 years of age. Community-wide surveillance of deaths, hospital discharges, myocardial infarction and stroke registry was carried out in the intervention and control areas. Four to five years of interventions based on different categories such as mass media, community partnerships, health system involvement and policy and legislation have started in the intervention area while Arak will be followed without intervention. Considering the results of the baseline surveys, (assessments needed, the objectives, existing resources and the possibility of national implementation) the interventions were planned. They were set based on specific target groups like school children, women, work-site, health personnel, high-risk persons, and community leaders were actively engaged as decision makers. A series of teams was arranged for planning and implementation of the intervention strategies. Monitoring will be done on small samples to assess the effect of different interventions in the intervention area. While four periodic surveys will be conducted on independent samples to assess health behaviours related to CVD risk factors in the intervention and reference areas, the original pre-intervention subjects aged more than 35 years will be followed in both areas to assess the individual effect of interventions and outcomes like sudden death, fatal and nonfatal MI and stroke. The whole baseline survey will be repeated on the original and an independent sample in both communities at the end of the study.     

Blood pressure patterns and cardiovascular risk factors in rural and urban gambian communities

Hypertension is emerging as an important public health problem in sub-Saharan Africa. We studied blood pressure (BP) patterns, hypertension and other cardiovascular risk factors in a rural and an urban area of The Gambia. A total of 5389 adults (> or =15 years) were selected by cluster sampling in the capital Banjul and a rural area around Farafenni. A questionnaire was completed, BP, pulse rate, height and weight were recorded. Glucose was measured 2 h after a 75 g glucose load among participants > or =35 years (n = 2301); total cholesterol, triglycerides, creatinine and uric acid were measured among a stratified subsample (n = 1075). A total of 7.1% of the study participants had a BP > or =160/95 mm Hg; 18.4% of them had a BP > or =140/90 mm Hg. BP was significantly higher in the urban area. BP increased with age in both sexes in both areas. Increasing age was the major independent risk factor for hypertension. Related cardiovascular risk factors (obesity, diabetes and hyperlipidaemia) were significantly more prevalent in the urban area and among hypertensives; 17% of measured hypertensives were aware of this, 73% of people who reported to have been diagnosed as hypertensive before had discontinued treatment; 56% of those who reported being on treatment were normotensive. We conclude that hypertension is no longer rare in either urban or rural Gambians. In the urban site hypertension and related cardiovascular risk factors were more prevalent. Compliance with treatment was low. Interventions aimed at modifying risk factors at the population level, and at improving control of diagnosed hypertension are essential to prevent future increases of cardiovascular morbidity and mortality. In view of limited resources and feasibility of intervention in rural Gambia, these could initially be directed towards urbanised populations.     

Hypertension among Tunisian adults: results of the TAHINA project

We performed a national survey to determine the prevalence, awareness, treatment and control of hypertension, one of the main cardiovascular risk factors, among the adult population in Tunisia. A total of 8007 adults aged 35-70 years were included in the study. Blood pressure (BP) measurements were taken by physicians with a mercury sphygmomanometer, and standard interviewing procedures were used to record medical history, socio-demographic and cardiovascular disease (CVD) risk factors. Hypertension was defined as a systolic BP ≥140?mm?Hg and/or diastolic BP ≥90?mm?Hg or current treatment with antihypertensive drugs. The prevalence of hypertension was 30.6%, higher in women (33.5%) than in men (27.3%). Multiple logistic regression analyses identified a higher age, urban area, higher body mass index, type 2 diabetes and family history of CVD as important correlates to the prevalence of hypertension. Only 38.8% of those with hypertension were aware of their diagnosis, of which 84.8% were receiving treatment. BP control was achieved in only 24.1% of treated hypertensive persons. Women were more aware than men (44.8 vs. 28.8%), but the rates of treatment and control of hypertension did not differ between the two genders. Higher age, being female, lower education level and urban area emerged as important correlates of hypertension awareness. The study highlights the hypertension problem in a middle-income developing country. There is an urgent need for a comprehensive integrated population-based intervention program to ameliorate the growing problem of hypertension in Tunisians.     

The epidemiology of hypertension in South America

Although cardiovascular disease (CVD) is the leading cause of death and disability in the majority of the countries in Latin America we have few data about regional differences on this topic. Developing countries have scarce epidemiological data on cardiovascular (CV) risk factor prevalence and subsequently in their control and treatment. The load of the CV risk factors, especially hypertension, remains uncertain. The methodology of investigation varies from country to country and the criteria to define 'hypertension' is different according to the survey year. Data on CVD from USA and Europe have been extrapolated to our continent but recently two large epidemiological studies have been conducted in the southern region: FRICAS, primary prevention, and PRESEA, secondary prevention. The first pointed out the importance of each cardiovascular risk factor, including hypertension, in the development of acute myocardial infarction (AMI), and the second showed the poor control of them and the necessity to improve them.     

Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study

Few data are available to clarify whether changes in albuminuria over time translate to changes in cardiovascular risk. The aim of the present study was to examine whether changes in albuminuria during 4.8 years of antihypertensive treatment were related to changes in risk in 8206 patients with hypertension and left ventricular hypertrophy in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Urinary albumin/creatinine ratio (UACR) was measured at baseline and annually. Time-varying albuminuria was closely related to risk for the primary composite end point (ie, when UACR decreased during treatment, risk was reduced accordingly). When the population was divided according to median baseline value (1.21 mg/mmol) and median year 1 UACR (0.67 mg/mmol), risk increased stepwise and significantly for the primary composite end point from those with low baseline/low year 1 (5.5%), to low baseline/high year 1 (8.6%), to high baseline/low year 1 (9.4%), and to high baseline/high year 1 (13.5%) values. Similar significant, stepwise increases in risk were seen for the components of the primary composite end point (cardiovascular mortality, stroke, and myocardial infarction). The observation that changes in UACR during antihypertensive treatment over time translated to changes in risk for cardiovascular morbidity and mortality was not explained by in-treatment level of blood pressure. We propose that monitoring of albuminuria should be an integrated part of the management of hypertension. If albuminuria is not decreased by the patient's current antihypertensive and other treatment, further intervention directed toward blood pressure control and other modifiable risks should be considered.