上海市社区老年高血压患者血压水平影响因素的多水平分析

目的 应用多水平分析模型分析社区老年高血压患者血压水平的影响因素.方法 通过多阶段随机抽样,抽取上海市23个社区的927例老年高血压患者作为研究对象,采用两水平线性多层模型分别分析社区老年高血压患者收缩压(SBP)和舒张压(DBP)的影响因素.结果 研究对象的平均血压水平为SBP(139.2±11.7)mm Hg、DBP(85.6±8.6)mm Hg(I mm Hg=0.133 kPa).在社区水平上,辖区高血压患者/站点医师数(医患比)"高"的社区较医患比"低"的社区患者的SBP低3.86 mm Hg、DBP低2.51 mm Hg.在个体水平上,年龄、性别、超重/肥胖是血压升高的危险因素;规律服药、限盐、疾病管理自我效能的提高可降低血压,特别是在控制其他影响因素后仅限盐1项就可降低SBP 2.44 mm Hg、DBP 2.03 mm Hg.结论 多水平分析模型可以灵活有效地处理具有层次结构的数据,社区因素和个体因素对老年高血压患者的血压水平均有影响.     

老年高血压用药有口诀

正老年高血压患者往往收缩压高,舒张压低。单位时间内心、脑、肾、血管等靶器官承受的血压变异大,导致靶器官易受损(脉压差≥60 mm Hg,为靶器官受损的危险因素),肾脏疾病、脑卒中、心衰、外周血管疾病等风险明显增加。因此,合理使用降压药,有效、平稳降血压,对老年高血压患者尤其重要。为了方便记忆,总结了以下老年高血压患者应该知道的用药口诀。     

何为高血压？

<正>高血压患者临床表现多为头晕、头痛、心悸、疲劳等。常见疾病危险因素为超重、肥胖、饮酒、遗传等。随着病情延长血压明显升高。临床多予利尿剂、β受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂控制。本文立足高血压诊断、检测、防治措施角度对高血压患者病情控制指导如下:高血压诊断与血压检测诊断标准。非同日3次测量血压见收缩压≥140mm Hg、舒张压≥90mm Hg即可确定为高血压。部分患者医疗机构测血压140/90mm Hg,24h动态血压均值 130/80mm Hg该群体为隐性高血压     

延续性护理对高血压患者血压及生活质量的影响

目的:探讨延续性护理干预对高血压患者血压及生活质量的影响。方法:以我院就诊的50例高血压患者作为研究对象。随机分为观察组与对照组,每组25例,对照组行高血压常规护理干预,观察组行系统延续性护理干预,定期对患者进行健康训练、饮食生活、用药及治疗依从性等多方面指导,持续性干预6个月。采集两组患者出院时及干预后血压并进行生活质量评价。结果:观察组干预后平均SP(138.7±5.9)mm Hg、DP(89.2±4.6)mm Hg,与出院时比较存在无显著差异,较对照组干预后有显著优势(P<0.05)。结论:对高血压患者采取延续性护理,可有效控制患者血压,并提高了患者生活质量。     

社区老年高血压患者用药时间对血压控制及预后影响

目的社区老年高血压患者普遍存在血压水平不稳定和预后差等一系列问题。为改善此类问题,本研究应用时间治疗学管理对社区老年高血压患者血压控制及预后的实际效用展开探讨。方法选择2018-09-10-2019-06-28深圳市龙岗区第二人民医院社区统筹门诊收治的社区老年高血压病患者作为研究对象,根据两组间性别、年龄、病程等因素均衡的原则,每组各选58例。对照组行早晨服用降压药治疗方案,观察组行夜间服用降压药方案,对治疗后高血压患者进行为期2个月随访,对比两组治疗前后的血压指数变化情况、临床症状疗效与不良反应。结果治疗后,观察组24h收缩压为(115.10±6.15)mm Hg,低于对照组的(126.43±5.62)mm Hg,t=9.552,P<0.001;24h舒张压为(72.95±6.08)mm Hg,低于对照组的(77.17±8.36)mm Hg,t=3.109,P=0.001;晨间收缩压为(120.71±10.07)mm Hg,低于对照组的(131.80±8.06)mm Hg,t=6.548,P<0.001;晨间舒张压为(72.98±8.15)mm Hg,低于对照组的(80.43±9.62)mm Hg,t=8.969,P<0.001;夜间收缩压为(120.71±10.07)mm Hg,低于对照组的(131.80±8.06)mm Hg,t=6.548,P<0.001;夜间舒张压为(69.71±9.07)mm Hg,低于对照组的(90.80±5.06)mm Hg,t=15.464,P<0.001。观察组治疗总有效率为94.83%,高于对照组的82.76%,χ~2=4.245,P=0.039。观察组术后并发症总发生率为10.34%,低于对照组的27.59%,χ~2=5.609,P=0.017。结论夜间服用降压药可改善社区老年高血压患者血压不稳定现象,有助于其改善疗效,安全性高。     

老年人慎防体位性低血压

正从卧位转为站立位最初3分钟内,收缩压下降≥20 mm Hg和(或)舒张压下降≥10 mm Hg、或卧位收缩压≥160 mm Hg的高血压患者收缩压下降≥30 mm Hg、或对于那些血压基线较底患者,在站立位时收缩压90 mm Hg时均可确诊为体位性低血压。体位性低血压也称为直立性低血压,是指体位发生改变时血压明显下降,而引起头晕、疲劳、视力模糊、认知障碍、头痛和晕厥等一系列症状的临床综合征。     

冠心病合并高血压患者血压达标情况及相关影响因素

目的探讨冠心病合并高血压患者血压达标情况及相关影响因素。方法选取2018年4月至2019年10月本院收治的冠心病合并高血压患者97例;将收缩压≥150 mm Hg或(和)舒张压≥90 mm Hg判断为血压未达标,将入选患者分为血压达标组与未达标组。收集两组高盐饮食、规律锻炼,合并基础疾病(糖尿病、高脂血症)等资料;检测外周血白蛋白、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白及血尿酸水平。结果 97例冠心病合并高血压患者中,血压达标39例(40.21%),血压未达标58例(59.79%)。血压未达标组患者中男性比例、年龄、体质量指数、吸烟史、饮酒史、高盐饮食、合并糖尿病的比例均明显高于血压达标组,受教育程度、规律锻炼的比例明显低于血压达标组,差异均有统计学意义(均P0.05)。血压未达标组患者规律用药比例明显低于血压达标组,差异有统计学意义(P0.01);目前服药数量在两组患者间比较差异有统计学意义(P0.01)。血压未达标组患者总胆固醇、低密度脂蛋白、血尿酸水平均明显高于血压达标组,差异均有统计学意义(均P0.05)。多因素Logistic回归分析显示,男性、高龄、体质量指数偏高、吸烟史、高盐饮食、合并糖尿病、总胆固醇偏高是冠心病合并高血压患者血压达标的独立危险因素(均P0.05),规律用药是保护因素(P0.05)。结论冠心病合并高血压患者血压达标率偏低,应针对男性、高龄、体质量指数偏高等危险因素制订针对性干预方案。     

2型糖尿病患者冠状动脉粥样硬化与高血压、肾功能减退和白蛋白尿的关系

目的探讨2型糖尿病患者冠状动脉粥样硬化(coronary atherosclerosis,CAS)与高血压、肾功能减退及白蛋白尿的关系。方法采用320排螺旋CT对247例无冠心病史的2型糖尿病患者进行检查,并测定血压、空腹血糖、糖化血红蛋白、血脂、肾小球滤过率估计值(estimated glomerular filtration rate,e GFR)和尿白蛋白排泌率等。结果 2型糖尿病患者肾功能减退或出现白蛋白尿时,血压≥130/80 mm Hg增加CAS危险;患者血压≥130/80 mm Hg时,肾功能减退或白蛋白尿增加CAS危险。多因素分析表明年龄、血压水平、e GFR水平、血压≥130/80 mm Hg、肾功能减退和白蛋白尿的发生均与CAS独立相关,而年龄、血压≥130/80 mm Hg、肾功能减退和白蛋白尿是CAS的独立危险因素。结论肾功能减退、白蛋白尿以及血压升高与CAS既互相独立,又相互促进。     

老年高血压的护理知识

<正>随着年龄的增大,老年人的身体机能也会出现退化现象,各种病症也会接踵而至,其中最常见的疾病要数高血压。高血压虽然是一种常见病,但是如果护理不当,也会导致老年人出现死亡,因此需要大家提高重视,并且对血压进行管控。老年高血压的病因老年高血压表现为收缩压≥140mmHg且舒张压≥90mmHg,高血压的病因多种多样,包括遗传因素、精神因素、饮食因素、环境因素、     

预防高血压的方法

正高血压的概述高血压是以动脉血压升高为主要临床表现的综合征,是指成年人在安静状态下收缩压≥140mm Hg和(或)舒张压≥90mm Hg;在高血压人群中有大部分(90%)的人为遗传的高血压即(原发性的高血压),仅有少部分(10%)的人是由于其他疾病引起的高血压(即继发性高血压);高血压病人同时还会出现心脏、大脑、肾脏等器官功能受到严重影响的一种疾病。我们根据血压的高低及器官受损的情况来分级,一共可以分为四级;一旦确诊为高血压之后就应该积极配合医生治疗使血压维持在相对稳定的范围内,这样可以减少并发症的发生,从而可以提高生活水平。     

天津市农民高血压患者自我管理项目效果评价

目的 对天津市某农村地区开展的高血压自我管理项目效果进行评价,为农村高血压患者自我管理模式提供依据.方法 在天津市某农村地区以自愿报名的方式纳入高血压患者175名,以镇为单位将其分成9个小组,通过定期开展高血压自我管理技能和知识为主要内容的小组活动,使组员掌握自我监测血压、合理膳食、体育锻炼等自我管理的相关技能.3个月后对参加该项目的高血压患者进行前后比较及效果评估.结果 活动后高血压防治知识知晓率较活动前增高,差异有统计学意义(P＜0.01)；活动后采用药物与非药物联合治疗的患者较活动前提高60.6％；血压控制率由活动前的19.43％,增加到活动后22.86％,差异无统计学意义(P＞0.05)；活动前收缩压为(145.19±15.73) mm Hg,活动后为( 143.17±14.48) mm Hg,差异无统计学意义(P=0.182)；活动前舒张压为(88.65±9.77) mm Hg,活动后为(86.69±8.09) mmHg,差异有统计学意义(P=0.028)；患者满意度为95.4％.结论 高血压自我管理项目能够提高农民高血压患者的高血压防治知识知晓率,改变不良生活方式,降低血压水平,提高自我管理的意识、信心和能力.     

Hypertension in the nursing home

Hypertension in a nursing home patient is a systolic blood pressure of 140 mm Hg or higher and 130 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency, or a diastolic blood pressure of 90 mm Hg or higher and 80 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency. Numerous prospective, double-blind, randomized, placebo-controlled studies have demonstrated that antihypertensive drug therapy reduces the development of new coronary events, stroke, and congestive heart failure in older persons. The goal of treatment of hypertension in elderly persons is to lower the blood pressure to less than 140/90 mm Hg and to less than 130/80 mm Hg in older persons with diabetes mellitus or chronic renal insufficiency. Elderly persons with diastolic hypertension should have their diastolic blood pressure reduced to 80 to 85 mm Hg. Diuretics should be used as initial drugs in the treatment of older persons with hypertension and no associated medical conditions. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their associated medical conditions. If the blood pressure is more than 20/10 mm Hg above the goal blood pressure, drug therapy should be initiated with 2 antihypertensive drugs, one of which should be a thiazide-type diuretic. Other coronary risk factors must be treated in patients with hypertension.     

社区高血压自我管理模式的干预及效果评估

目的评估高血压自我管理干预措施的效果,为社区高血压病的预防控制工作提供依据。方法 2013年5—11月选择中山市某社区开展高血压自我管理健康教育干预,通过招募高血压患者并建立自我管理小组,对小组长进行规范的培训与授课,再由小组长召集组员开展相关宣传教育干预,搜集高血压患者自我管理健康教育课程前后知、信、行各项指标及血压、血脂的变化情况,评估其效果。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果高血压患者对疾病认识,运动知识,膳食知识、药物治疗知识、心理调节知识、血压自我监测知识等6方面知识知晓率均显著提高(P0.05);自我管理能力如不吸烟、限制饮酒、坚持有氧运动、坚持低盐低脂饮食、坚持服用药物、自我监测血压、情绪控制良好等7个方面的自我管理能力均得到良好的改善(除不吸烟外,其余项(均P0.05);患者血压水平干预后出现好转,平均收缩压由干预前的(168.72±21.33)mm Hg(1 mm Hg=0.133 kPa)降低到干预后的(142.26±19.37)mm Hg,平均舒张压由干预前的(101.22±11.45)mm Hg降低到干预后的(90.32±11.98)mm Hg,比较差异均有统计学意义(均P0.05);血脂三项干预前后也出现好转(P0.05)。结论对高血压患者开展自我管理能力培训,充分发挥患者自我管理效能和病人自身的能动性,提高对疾病的认识,改善不健康的生活行为方式,才能真正有效地控制社区高血压病,最大限度减少疾病所引起的并发症。     

Integration of depression and hypertension treatment: a pilot, randomized controlled trial

PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications, depression outcomes, and blood pressure control among older primary care patients.METHODS Older adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence.RESULTS In all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.CONCLUSION A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where there are competing demands for limited resources.     

Narrowing the gap in hypertension: effectiveness of a complex antihypertensive program in the elderly.

Hypertension control is a difficult goal to achieve in common practice even when its benefits have been widely proved. We assessed the effectiveness of a Complex Antihypertensive Intervention Program in the Elderly (CAPE). A program trial of 500 elderly hypertensive patients was conducted. 250 were followed by primary care physicians and intervened by the CAPE and 250 received usual care. The program included an organizational change with the addition of an office where patients had their blood pressure measured, were appointed to join educational sessions and received verbal and printed advice before medical attendance. Data was systematically recorded in the electronic medical record which functioned as a physician reminder during the visit. Differences in systolic blood pressure level and in percentage of well-controlled (<140/90 mm Hg) patients between groups were measured after 12 months of follow-up. The difference of mean change in systolic blood pressure between groups was 7.1 mm Hg (95% confidence interval, 4-10 mm Hg). Sixty-seven percent of patients in the intervention group were well-controlled, as were 51% of patients in the control group (p < 0.001). Patients who attended educational sessions showed the lowest odd ratio (0.25; 95% confidence interval, 0.11-0.54) for blood pressure above 140/90 mm Hg in multivariate analysis after adjusting for age, sex, initial systolic blood pressure level, and changes in antihypertensive treatment. These results support the effectiveness of our complex intervention program. Routine clinical care of hypertension can be improved with simple strategies that go beyond pharmacotherapy, tending to overcome clinical inertia.     

Case in Point

Abstract

Epidemiologic and clinical trial data suggest that blood pressure in patients with hypertension who are at high risk for cardiovascular events because of coronary artery disease, diabetes, chronic kidney disease, stroke, or heart failure should be reduced to < 140/90 mm Hg in patients aged < 80 years, and that systolic blood pressure should be reduced to 140 to 145 mm Hg, if tolerated, in patients aged ≥ 80 years. Studies on patients with coronary artery disease, diabetes, chronic kidney disease, stroke, and heart failure are discussed, supporting a blood pressure goal of < 140/90 mm Hg in patients aged < 80 years who are at high risk for cardiovascular events.     

The prevalence of hypertension in 4,993 rural Zulus

In a study of 4,993 rural Zulus the over-all prevalence of primary hypertension was 8·37% (females 8·78%, males 7·4%). The mean arterial pressure in relation to age and sex was not as high as in urban Zulus. A diastolic blood pressure of ≥ 95 mm Hg was present in 4·99% of the subjects and 1·46% had a diastolic blood pressure of ≥ 110 mm Hg. This study suggests that hypertension is not a major health problem in rural Zulus and that large case-finding and intervention programmes should be confined to the urban Black population of South Africa.     

The effect of intensified diet counseling on the diet of hypertensive subjects in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland

BACKGROUND: Diet is an essential part of the nonpharmacological management of hypertension. The aim of this study was to investigate in a primary health care setting the effect of intensified diet counseling on the diet of hypertensive subjects. METHODS: A total of 715 free-living subjects, ages 25-74 years, with systolic blood pressure 140-179 mm Hg and/or diastolic blood pressure 90-109 mm Hg and/or drug treatment for hypertension participated in an open randomized trial with a 2-year follow-up at health centers in eastern Finland. The intervention group (n = 360) was advised to reduce their total fat, saturated fat, and salt intake and to increase monounsaturated and polyunsaturated fat intake as well as to reduce weight and to use alcohol in moderation if at all. The usual care group (n = 355) continued with their usual primary health care. The subjects filled out a 4-day food record, and 24-h urine samples were collected at baseline and at 1- and 2-year examinations. RESULTS: The 2-year net changes (change in intervention minus change occurring in usual care group) in total fat intake [-2.7 E% (95% CI -4.0, -1.6; P < 0.0005)], in saturated fatty acid intake [-1.7 E% (95% CI -2.3, -1.1; P < 0.0005)], and in body weight [-1.4 kg (95% CI -2.0, -0.8; P < 0.0005)] were significant. Furthermore, the 2-year net change in daily sodium intake was significant, -9 mmol (95% CI -17, -2; P = 0.021), but the 24-h urinary sodium excretion showed no difference between the study groups. CONCLUSION: The intensified diet counseling in primary health care resulted in dietary changes interpreted as being of benefit in the long-term treatment of hypertension and prevention of atherosclerotic vascular diseases.     

Excessive Lowering of Blood Pressure Is Not Beneficial for Progression of Brain White Matter Hyperintensive and Cognitive Impairment in Elderly Hypertensive Patients: 4-Year Follow-Up Study

ObjectivesThis study was designed to explore the appropriate blood pressure (BP) target required to reduce cognitive decline and brain white matter lesions (WMLs) in elderly hypertensive patients.MethodsElderly patients (n = 294, ≥80 years of age) being treated for hypertension were enrolled in a longitudinal study examining cognitive impairment after an initial assessment and a period of 4 years. All patients underwent neurological and cognitive assessment, laboratory examination, and magnetic resonance imaging of the brain.ResultsThe 4-year follow-up examination revealed that body mass index, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure, and Mini-Mental State Examination (MMSE) all showed a significant decline, whereas fasting plasma glucose, white matter hyperintensities (WMH) volume, and the WMH/total intracranial volume (TIV) ratio were significantly increased when compared with baseline observations. Interestingly, the decline in MMSE, as well as the increment of WMH and WMH/TIV ratio was smaller in patients with SBP ranging from 140 to 160 mm Hg than in those whose SBP was lower than 140 mm Hg or higher than 160 mm Hg (P < .05). Furthermore, we observed that a 15 to 35 mm Hg targeted lowering of SBP in the elderly patients was more beneficial to our cognitive analysis than treatments that achieved less than 15 mm Hg or greater than 35 mm Hg (P < .05).ConclusionsIn elderly hypertensive patients, there exists a beneficial target for SBP lowering beyond which treatment may not be beneficial for improving or delaying the progression of cognitive impairment and WMLs.