社区高血压患者药物治疗及血压达标现状的调查研究

目的调查社区高血压患者血压达标及药物治疗现状,分析其影响因素。方法选择在社区随访的高血压患者756例,记录患者年龄、性别、文化程度、经济收入、是否医保、高血压病程、合并症及就诊时血压和药物治疗情况。结果服药治疗率93．38％,达标率41．75％,合并糖尿病达标率27．88％。单一用药77．76％,联合用药22．23％;单一用药达标率42．07％,联合用药达标率42．67％,两者相比无统计学意义（P〉0．05）。血压达标与患者性别、文化程度、是否医保之间无统计学意义（P〉0．05）。血压达标与患者的经济收入和高血压病程之间有统计学意义（P〈0．05）。结论社区高血压患者血压达标率低,其原因与单一用药比例较大、药物选择、药物配伍不合理、患者的经济收入及高血压病程有关。需加强社区高血压管理,以提高高血压患者治疗率和达标率。     

上海市杨浦区45岁以上人群高血压患病及药物治疗的现状调查

目的了解上海市杨浦区45岁以上人群高血压的患病及降压药物应用现状,为人群干预做基线调查。方法采用随机整群抽样方法,选取上海市杨浦区5个社区居委1502人进行病史、生活方式及2周内高血压服药情况调查,并测量血压、血糖、血脂等生化指标。根据血压控制达标情况分为血压控制组及未控制组。结果高血压标准化患病率为37.1%,583人男性中有高血压患者219人（37.6%）,919位女性中有高血压患者338人（36.8%）。高血压知晓率、治疗率、控制率分别为87.4%、74.9%、29.4%;男性患者的高血压控制率低于女性患者（P〈0.05）。血压控制组与未控制组在吸烟人数、总胆固醇（TC）、低密度脂蛋白（LDL-C）这三个变量存在显著差异（P〈0.05）。降压药物使用方面,血压控制组选择二药连用的人多于未控制组,而未控制组使用复方降压药物的人多于血压控制组（P〈0.05）。结论社区高血压控制率依旧处于较低水平,社区卫生服务中心应强化对中老年高血压患者降压药物使用的规范管理与跟踪调查。     

苯磺酸左旋氨氯地平治疗老年单纯收缩期高血压的临床观察

目的利用动态血压监测观察老年单纯收缩期高血压（ISH）患者在不同时间服左旋氨氯地平降压治疗疗效,探讨其临床意义。方法选未服用降压药物或停用其他降压药物治疗7天以上的86例老年单纯收缩期高血压（ISH）患者,随机分为早上服药组（n=42例）和晚上服药组（n=44例）,口服苯磺酸左旋氨氯地平2．5mg／d,每日观察诊室血压。所有患者药物治疗前后行动态血压监测,共治疗12周。结果经左旋氨氯地平治疗后2组患者诊室血压明显降低（P〈O．05）,且下降程度相近,无统计学意义（P〉0．05）。动态血压显示2组治疗后均能降低24h血压,降压程度相近,无统计学意义（P〉0．05）。早上服药组白天血压达标（SBP〈135mmHg）者占46．2％,夜间血压达标（SBP〈125mmHg）者占31．7％。晚上服药组白天血压这标（SBP〈135mmHg）者占42．5％,夜间血压达标（SBP〈125mmHg）者占51．3％。结论左旋氨氯地平对老年单纯收缩期高血压（ISH）患者有较好的降压效果,特别是对夜间血压升高非杓型高血压患者在晚上服药可以提高夜间血压达标率,更好纠正血压昼夜节律异常,以减少高血压患者心、脑、肾等靶器官损害。     

广州市某社区高血压自我管理效果的影响因素分析

目的了解影响高血压自我管理效果的因素,提升高血压患者自我管理能力。方法采用自制的一般资料调查表、高血压防治知识问卷调查表及高血压自我管理生活行为习惯及用药情况调查表,选取广州市某社区已参加高血压自我管理的患者359名为研究对象,对其进行调查。结果老年女性（P=0．024）、有配偶（P=0．018）、69岁以下（P=0.045）、不伴有腰腿疼痛性疾病（P=0.012）的高血压患者健康行为形成率高,差异有统计学意义（P〈0.05）;文化程度高（P=0.047）、月收入高（P=0.026）、59岁以下（P=0．018）的高血压患者,高血压健康知识知晓率高,差异有统计学意义（P〈0.05）;有经济生活来源（P=0.032）、文化程度高（P=0．047）、心理状况家庭关系良好（P=0．028）、长期规律服药（P=0．015）的患者血压控制率较高,差异有统计学意义（P〈0.05）。结论影响高血压自我管理效果的因素有年龄、性别、文化程度、生活来源、家庭关系、长期规律服药情况等,中年女性、文化程度高、家庭关系好、有稳定的生活来源、长期规律服药的高血压患者,其健康行为形成率、健康知识知晓率及血压控制率较好。     

郴州市、县级医院118例妊娠高血压住院患者的临床分析

目的分析郴州市、县医院近年来妊娠高血压综合征住院患者临床病情特点及用药治疗情况。方法随机抽取2009年以来郴州市、县医院住院的118例妊娠高血压综合征患者的作为研究对象,分析其临床特点及对其进行药物治疗分析。结果报告的118例住院患者血压控制率为84．75％,市级医院血压控制率高于县级医院（P〈0．01）;妊高症合并1种临床相关疾病者占72．88％;城区居民妊高症患者对妊高征疾病知晓率高于农村（P〈0．01）,城乡居民妊高症患者对妊高症的危害及病因知识均明显不足;城区居民妊高症患者非高血压药物治疗措施高于农村（0．01〈P〈0．05）;市级医院单用降压药物高于县级医院（0．01〈P〈0．05）,而县级医院联合降压用药高于市级（P〈0．01）。结论妊娠高血压住院患者临床情况严重,患者对其危害及病因知识均明显不足;降压用药治疗中,市、县级医院存在差异。建议在确保母婴安全的前提下,提高妊娠高血压疾病非药物治疗措施,并重视开展妊高症的基层社区防治。     

心理护理对原发性高血压患者药物治疗疗效的影响

目的：探讨原发性高血压患者人院时的心理特点及心理护理对降压效果的影响。方法：入选2006年4月-2007年8月入住石景山医院心内科的85例原发性高血压患者，按SCL-90量表调查，将有心理障碍的患者随机分为A、B组；无心理障碍的患者分为C、D组；A组C组患者予降压药物，B组和D组患者予降压药物的同时给予心理护理，观察4周时患者血压控制水平。结果：入选患者存在心理障碍者共51例（占60％），其中前三位依次为焦虑（32．94％）、抑郁（28．24％）、躯体化（15．29％）。B组血压控制优于A组（P〈0．01）；D组血压控制优于C组（P〈0．01），血压下降幅度B＋D组明显超过A＋C组（P〈0．01）。结论：加强心理护理有助于增强原发性高血压患者药物治疗基础上的降压效果。     

低强度运动匹配负离子对老年高血压患者的影响

目的探讨低强度运动匹配高浓度负离子对老年高血压患者血压及血脂的影响。方法122例老年轻、中度高血压患者随机分为治疗组58例和对照组64例,两组均给予非洛地平缓释片5mg／d＋贝那普利片10mg／d口服,治疗组在服药同时予每周4次以上的低强度运动匹配30～60min在高浓度负离子区的空气浴,4周后依血压情况调整服药剂量,随访6个月,观察两组血压、血脂及服药量的差异。结果4周后治疗组降压效果优于对照组（P〈0．05）,血压控制达标率67．2％vs48．4％,高于对照组（P〈0．05）;6个月后在血压均控制在目标值时,治疗组服药剂量明显低于对照组（P〈0．01）,药物不良反应发生率明显低于对照组（P〈0．01）,治疗组血脂明显下降（P〈0．05）,对照组血脂无明显变化（P〉0．05）。结论低强度运动匹配高浓度负离子对老年高血压患者具有降压及降血脂作用。     

糖尿病合并高血压患者降压用药情况调查分析

目的了解糖尿病高血压患者的用药现状，分析其降压药物使用情况，为合理治疗提供依据。方法将入选病例分为观察组（高血压合并糖尿病）和对照组（未合并糖尿病），回顾性调查两组患者降压药物使用情况，包括降压药的使用种类、频率及联合用药情况。结果观察组降压治疗方案中使用较多的是血管紧张素转换酶抑制荆（ACEI）和血管紧张素Ⅱ受体阻断药（ARB），其平均服用降压药物种类要显著多于对照组（P〈0．05）。结论对于糖尿病高血压患者。应综合分析患者的危险水平、降压疗效、对临床终点事件的影响、治疗的依从性和安全性及经济状况等，构建合理的治疗方案。     

氯沙坦治疗高血压并高尿酸血症55例临床观察

目的：观察氯沙坦治疗原发性高血压并高尿酸血症的降压和降尿酸作用。方法：55例高血压并高尿酸血症患者随机分为治疗组与对照组,观察给药前后血压和血尿酸变化。结果：用药4周后两组患者收缩压和舒张压与治疗前比较差异有统计学意义（P〈0．01）,两组间降压疗效比较差异无统计学意义（P〉0．05）;治疗组用药4周后与用药前比较血尿酸浓度差异明显（P〈0．01）,而对照组用药4周后与用药前比较血尿酸浓度差异无统计学意义（P〉0．05）。结论：氯沙坦可降低高血压合并高尿酸血症患者血压和血清尿酸水平,合并高尿酸血症的高血压病人可安全选用氯沙坦。     

高血压合并糖尿病患者降压用药情况调查分析

目的：了解高血压合并糖尿病患者的用药现状，分析其降压药物使用情况，为合理治疗提供依据。方法：将入选病例分为观察组（高血压合并糖尿病）和对照组（未合并糖尿病），回顾性调查两组患者降压药物使用情况，包括降压药的使用种类、频率及联合用药情况。结果：观察组降压治疗方案中使用较多的是血管紧张素转换酶抑制剂（A-CEI）和血管紧张素Ⅱ受体阻断药（ARB），其平均服用降压药物种类要显著多于对照组（P〈0．05）。结论：对于合并糖尿病的高血压患者，应综合分析其危险水平、降压疗效、对临床终点事件的影响、治疗的依从性和安全性及经济状况等，构建合理的治疗方案。     

干体重控制及低钠透析对血透患者高血压控制的作用

目的探索基于不同病因的个体化治疗模式对改善血液透析(HD)患者高血压控制率的影响。方法选取我院部分稳定维持性HD患者进行家庭血压(Home-BP)监测,以家庭血压的收缩压(Home-SBP)≥150mmHg为未控制的高血压的诊断标准,对入组高血压患者进行干预研究。行生物电阻抗检测,血清钠测定,药物使用情况调查,了解水、钠负荷及药物应用合理性情况,有针对性地分别进行降低干体重、低钠透析和合理使用降压药物的干预措施。随访2个月,观察患者高血压控制情况。结果 105例稳定维持性HD患者接受了Home-BP监测,其中未控制的高血压患者60例(57.1%)。其中30例患者容量超负荷,针对性地降低干体重后,Home-SBP下降12.0mmHg(P0.001),家庭血压的舒张压(Home-DBP)下降5.0mmHg(P=0.002),降压药用量显著减少(P=0.030)。12例透析前血钠低于标准透析液钠浓度(138mmol/L)的患者使用低钠透析(136mmol/L)后,Home-SBP下降14.0mmHg(P=0.003),Home-DBP下降8.1mmHg(P=0.014),降压药用量无明显变化(P=0.390)。余18例患者通过增加肾素-血管紧张素抑制剂和抗交感治疗,Home-SBP下降11.6mmHg(P0.001),Home-DBP下降4.2mmHg(P=0.021)。通过上述治疗,患者未控制的高血压比例从57.1%(60例)降至31.4%(33例)(P0.001)。结论对HD高血压患者进行有针对性的、个体化的干预治疗措施,能够有效地改善HD高血压患者血压状况。     

150例高血压患者降压药物治疗的随访调查

目的了解社区高血压患者的降压药物治疗情况和存在的问题。方法对150例居住在社区正在接受降压药物治疗的高血压患者进行6个月的随访调查。结果150例患者中有132例选用的是指南推荐的一线降压药物;首选单一降压药物的94例,首选联合用药的56例;随诊期内有不良反应和副作用17例;经降压药物治疗,达标者41例。结论尽管符合指南提示的在合用或用复方制剂之前先试用单一药物的原则,但对血压高于正常范围20/10mmHg的患者,应采用两种以上药物的治疗。     

Use of shopping centres in screening for hypertension

In two Edmonton shopping centres 9591 people were screened for hypertension: 3.3% were found to be normotensive but taking antihypertensive medication and another 8.8% were found to have elevated blood pressure. Systolic hypertension alone accounted for 45.3% of the hypertensive cases and diastolic hypertension, with or without systolic, for 54%. Of the group with elevated blood pressure 34.5% had been previously unaware of their condition, 18.7% had never received medication for it, 18.2% had received medication in the past but had discontinued it, 26.1% were still on medication and 2.5% were not taking antihypertensive medication and were uncertain if they had ever done so in the past. Eighty-eight percent of the hypertensives who were receiving no medication went to their physician; 41% were prescribed antihypertensive medication, and 87% were still on treatment three months later and 74% one year after detection. Eighteen percent of those started on treatment had their medication discontinued by their doctor over the next year and 8% stopped treatment on their own. Of those hypertensives already receiving medication 88% went to their doctor and 33% had their medication altered.

Physician measurements of blood pressure tended to be lower than those recorded at the screening. At least part of the explanation for this discrepancy is that physicians often used blood pressure cuffs that were too wide for the patient's arm; 25% of the people screened required cuffs narrower than the standard cuff used by most physicians.

The prevalence of hypertension was similar among women taking oral contraceptives and women not taking these agents.

     

Trends in the prevalence and treatment of hypertension in Halifax County from 1985 to 1995

BACKGROUND: The objective of this study was to document changes in the prevalence and treatment of hypertension in Halifax County from 1985 to 1995 in an effort to observe, at the population level, the consequences of the availability of new antihypertensive medications. METHODS: The study population comprised a random sample of Halifax County residents, aged 25-64 years, who responded to the 1985 and 1995 surveys of the Halifax County MONICA Project and residents who responded to the Nova Scotia Health Survey conducted in 1995. Data from the two 1995 surveys were pooled. Information on hypertension awareness and use of medication were obtained through questionnaires, and blood pressure was measured according to a standard protocol, using phase I and V of Korotkoff sounds as respective markers for systolic and diastolic pressures. Uncontrolled hypertension was defined as a systolic pressure of 140 mm Hg or greater and a diastolic pressure of 90 mm Hg or greater. Changes in the prevalence of hypertension, prescribing trends and medication costs were examined, and the association between the type of antihypertensive treatment and characteristics of the respondents with self-reported hypertension was investigated by multivariate logistic regression. RESULTS: Of the 917 people interviewed in 1985 and the 1338 in 1995, 274 (29.9%) and 356 (26.6%), respectively, reported a history of hypertension. When age was controlled for, the proportion of respondents reporting hypertension did not differ between survey years or between men and women. The proportion of treated respondents who had uncontrolled hypertension increased between 1985 and 1995, from 32.6% to 57.4% among men and from 38.0% to 42.6% among women. An increase was seen in the use of calcium-channel blockers (from 2.1% to 19.7%) and angiotensin-converting-enzyme inhibitors (from 5.2% to 25.4%); the proportion of patients receiving combination therapy or diuretics decreased (from 39.6% to 15.6% and from 31.3% to 17.2% respectively). These changes were associated with an increase in the average daily cost of medication from $0.48 to $0.85 per patient. INTERPRETATION: The shift to new antihypertensive drugs was not associated with improved blood pressure control, but it was associated with an increase in average medication costs per patient. Uncontrolled hypertension remains a public health problem.     

依那普利治疗原发性高血压的临床观察

本文对68例原发性高血压患者,随机分为两组。观察依那普例(enalapril)的降压效果,并与巯甲丙脯酸进行比较。依那普利组共44例;巯甲丙脯酸对照组24例。结果依那普利的降压有效率为86.4%,降压幅度为21.2/14.4mmHg,与巯甲丙脯酸的疗效相似。无明显不良反应。依那普利的半衰期和降压作用持续时间较长。每天服药一次或二次,即能控制24 h血压,较巯甲丙脯酸更方便于病人应用。     

不同剂量叶酸联合降压药治疗H型高血压的临床对比分析

目的：对比分析不同剂量叶酸联合降压药治疗H型高血压的临床疗效。方法整群选取该院2014年7月—2016年1月收治的156例H型高血压患者,随机分为3组,各52例。A组口服小剂量(0.8 mg)叶酸片+马来酸依那普利片,B组口服大剂量叶酸片(5 mg)+马来酸依那普利片,C组仅予马来酸依那普利片治疗。比较3组治疗效果。结果A组、B组治疗后收缩压、舒张压、Hcy水平分别为(119.86±8.56)mmHg、(73.41±7.89)mmHg、(12.25±5.96)μmol/L和(120.85±9.04)mmHg、(75.02±9.96)mmHg、(11.89±6.14)μmol/L,均明显低于C组的(134.33±11.25)mmHg、(84.27±6.50)mmHg、(16.77±4.92)μmol/L,(P<0.01),A组、B组间比较,差异无统计学意义(P>0.05)。结论叶酸联合降压药治疗H型高血压能明显改善血压与Hcy水平,小剂量用药即可达到较好效果。期待大规模临床实验进一步研究探讨。     

Long-term follow-up of a hypertension screening program.

Of 185 people found to be hypertensive in a shopping centre screening program who went to their physician and had medication prescribed, then were contacted 18 months later, 33 had discontinued the medication at their physician's request. But of 152 who were to continue taking medication 139 (91.4%) had complied. Blood pressure had decreased to less than 160 mm Hg systolic or less than 95 mm Hg diastolic, or both, in 65.1% of the 152; was 160 to 169 mm Hg systolic or 95 to 99 mm Hg diastolic, or both, in 13.8%; was mildly or moderately decreased but still above 169 mm Hg systolic or 99 mmHg diastolic, or both, in 8.6%; and was higher than before the onset of treatment in 3.9%. Adequacy of blood pressure control was not related to age, sex, initial blood pressure values, awareness before the screening of having hypertension, or treatment for hypertension before the screening. Diuretics had been prescribed for 93.5% of the 139 patients, most often as single-pill combinations with other antihypertensive agents.     

Effect of trial therapy on subsequent therapy. A review of patients with hypertension who have completed a pharmacological intervention study

After a clinical trial was completed in which two commonly used antihypertensive agents (prazosin and propranolol) were compared, 20 previously untreated men with moderate, asymptomatic, essential hypertension returned to the care of their general practitioners. Twelve months later 17 patients who were still attending the same doctor demonstrated improved blood pressure control with a decrease in their lying diastolic blood pressure from 96 +/- 2 mmHg to 91 +/- 2 mmHg (P less than 0.01). Only two of the 17 patients had not by then achieved satisfactory control. Eleven patients (65%) were still taking at least one of the trial medications; clinicians seemed to prefer prazosin (10 patients). Only one of seven patients was still taking propranolol although five patients had begun treatment with other beta-blocking agents. One patient had ceased drug treatment. This survey indicates that many general practitioners are able to maintain or even improve blood pressure control in patients whose blood pressure has been stabilized initially. However, the reasons for the medication preference were unclear and studies of the clinical behaviour that influences a general practitioner's choice of medication are required.