北京市城乡社区卫生服务中心高血压防治现状的对比研究

目的了解北京市城乡社区卫生服务中心的高血压防治现状,为有针对性地指导其开展高血压防治工作提供参考.方法在北京市城乡分别抽取2个社区,对主要在社区卫生服务中心就诊的高血压患者(下称社区就诊患者)进行抽样问卷调查.共调查780人,用于本研究分析的资料完整者共761人.血压、身高和体重等指标均采用国际标准化方法进行测量.结果 (1)血压控制率目前北京市社区就诊患者的血压控制率(血压<140/90 mm Hg,1 mm Hg＝0.133 kPa)城乡分别为47.4%和24.6%,农村显著低于城市.(2)相关知识知晓率社区就诊患者对高血压诊断标准的知晓率城乡分别为30.4%和8.2%;对发病危险因素的知晓率(除精神紧张外)不超过20%;对冠心病和脑卒中以外的其他高血压主要并发症很少知晓.(3)检出途径出现高血压相关症状或发生了严重并发症后到医院检查时发现的高血压城乡分别为60%和70%.(4)药物治疗情况城乡社区就诊患者95%均接受药物治疗,治疗药物均以钙拮抗剂和复方制剂为主,利尿剂使用比例极低.(5)非药物治疗情况社区就诊患者接受非药物治疗的比例城乡分别为71.6%和26.6%.农村患者自述医生曾为其提供过非药物治疗建议的比例约12%,显著低于城市患者.(6)患者随访情况城乡分别只有2.1%和3.6%,社区就诊患者的随诊是医生要求的.结论北京市城乡社区卫生服务中心在高血压的检出、治疗、随访管理和健康教育的各环节均存在很大不足,亟待加强和改善.     

社区老年高血压控制效果及其影响因素分析

目的分析社区老年高血压控制效果及其影响因素。方法将2015年10月~2016年4月本社区收治的老年高血压患者326例作为观察对象。对患者进行问卷调查,分析调查结果。结果是否规范管理、高年龄、有无并发症、是否按时就诊是影响血压控制效果的相关因素;经多因素分析显示,有无并发症、是否规范管理、是否按时就诊是影响血压控制效果的高危因素。结论社区老年高血压的防治应加强规范管理,督促患者按时就诊,重视并发症的治疗,提高控制效果。     

氯沙坦在老年人高血压社区干预的评价

目的 探讨老年高血压应用氯沙坦和有效社区干预治疗的临床效果.方法 根据老年高血压患者的临床和心理特征.给予氯沙坦药物治疗的同时进行有效社区干预.结果 根据老年高血压并发症多、血压波动大、易受体位变动的影响等临床特征.经氯沙坦(50～100) mg/d治疗8周后,患者血压均有明显改善.同时经过社区全面干预治疗,24例老年高血压患者中,尚可5例,优良19例,总有效率100%.结论 通过对高血压患者特别是老年高血压患者行社区干预,能显著提高患者药物治疗依从性,增强药物治疗效果.为老年人建立健康档案,加强对老年高血压患者及家属的教育,积极开展社区高血压防治健康讲座等方式,可提高老年人高血压防治效果.     

老年高血压患者治疗及随访观察

目的分析老年高血压患者治疗及随访情况,探讨有效的治疗和随访方案。方法对我院老年病门诊及内科住院60岁以上200例高血压患者进行治疗及跟踪随访。结果干预前200例患者高血压知晓率为27%,通过对老年高血压患者防治知识宣传,高血压知晓率为62%,干预前后高血压知晓率比较,差异有统计学意义(P<0.05)。干预前200例患者血压控制达标率为41.5%,干预后的血压控制达标率为76.5%,干预前后血压控制达标率比较,差异有统计学意义(P<0.05)。结论采取科学的治疗措施,开展广泛的健康教育,进行定期随访观察对于控制高血压,改善患者依从性有积极的意义。     

社区老年高血压合并糖尿病的临床治疗分析

目的调查分析社区老年原发性高血压合并糖尿病(DM)患者治疗以及用药情况,探讨临床治疗效果。方法以笔者单位2012年2月~2014年1月收治的78例老年原发性高血压合并Ⅱ型糖尿病(T2DM)患者的用药情况及治疗效果进行跟踪式调查;并就治疗效果及用药情况进行统计分析。结果本组78例老年原发性高血压合并T2DM患者在社区医院临床医师的治疗、指导之下,患者血压、血糖均得以明显改善,与治疗前比较(P0.05),具统计学意义。78例患者未发生较为明显的不良反应及并发症。结论对社区老年原发性高血压合并T2DM患者予以不同的降压和降糖药物进行治疗及维持性用药,既可以有效地控制老年原发性高血压合并T2DM患者的血压和血糖,还可以最大程度地避免或降低了相关并发症的发生;进而全面提升患者的生存质量。     

老年高血压并发症临床治疗研究进展

<正>据《中国心血管病报告2016》概要[1]显示,我国有高血压患者2. 7亿例。高血压多发于中老年人。年龄大于65岁,血压持续或非同日3次以上超过标准血压为诊断标准,即收缩压≥140 mmH g(1 mmH g=0. 133 kPa)和(或)舒张压≥90 mmH g,称为老年高血压。我国某社区的对1 500名居民的调查[1,2]中发现,老年高血压患者有912人,占60. 8%,而知晓率是67. 9%,治疗率是35. 4%,控制率为13. 6%。在成都社区80岁以上高血压患病率     

北京市军队干休所80岁以上老年人1002例高血压及治疗现状调查

目的 调查分析北京市军队干休所80岁以上老年人高血压的患病率、知晓率、服药率、控制率、治疗现状及伴随的心脑血管病、糖尿病等疾病的患病率。方法 入户调查北京市28个军队干休所80～99岁的老年人1002例，测量血压，按调查表收集所需相关资料，并查阅干休所门诊部的体检表或定点医院的住院病历，进行分析总结。结果 1002例中，高血压患者673例，患病率为67．17％，其中单纯收缩期高血压（ISH）45：3例，占高血压的67．61％；高血压的知晓率为91．08％，服药率为78．60％，控制率为60．03％；高血压组患者的冠心病、脑血管病、痴呆、致残、肾功能不全、高胆固醇血症、糖尿病、糖耐量减低的发生率明显高于非高血压组。结论 北京市军队干休所80岁以上老年高血压患者中以ISH为主，高血压患病率高，知晓率、服药率及控制率也高，药物治疗以服用钙拮抗剂为主，积极治疗和控制高血压对提高老年患者的生活质量和远期生存率具有重要意义。     

上海市徐汇区天平街道社区高血压患者2年随访管理效果及其影响因素

目的:分析社区随访管理对高血压病患者的血压控制效果,为进一步提高随访管理工作水平提供参考。方法:对上海市徐汇区天平街道社区535例高血压患者按照标准流程进行为期2年的规范化分级随访管理,记录随访结果,并进行统计学分析。结果:经过2年标准化、规范化的分级随访管理后,高血压患者的防治知识知晓率、医嘱依从性、血压控制水平均有显著提高(P<0.01),影响血压控制的因素有服药情况、非药物治疗措施、年龄和吸烟情况。结论:通过社区高血压综合防治,可有效实现防治高血压的基本目标。     

老年患者的血压管理

老年高血压患者快速增多,他们临床上有收缩压高、波动大、昼夜节律异常、白大衣高血压与假性高血压多等特点。老年患者一般血压150/90 mmHg以上开始降压并须降到该血压值以下,如耐受可降至140/90 mmHg以下,但高龄患者一般情况下不宜低于130/60 mmHg。治疗方法包括非药物治疗与药物治疗,常用药物也是指南推荐的五大类。单纯收缩期高血压、清晨高血压及多病共存状态是老年高血压患者常见类型,而且难治性高血压多见,临床上需要注意合并有体位性血压变异、餐后低血压等老年高血压的特殊问题。     

高血压健康教育在社区慢性病防治中的应用探讨

目的探索研究高血压健康教育在社区慢性病防治中的应用。方法选取本社区的高血压患者总共82例,将选取的82例患者随机平均分成观察组和对照组两组。观察组与对照组的所有患者均采用常规药物治疗方法进行降压治疗,在常规治疗的基础上给予观察组患者健康教育活动。在进行3个月的治疗以及健康教育后,测试观察组患者与对照组患者对高血压相关知识的掌握程度。监测两组患者的血压情况,比较两组患者的降压效果。观察两组患者的并发症发生情况。结果观察组患者治疗后的知晓率比对照组患者的知晓率高,差异显著(P0.05),具有统计学意义。观察组患者降低血压的总有效率与对照组相比较有显著差异(P0.05),具有统计学意义。观察组患者的并发症发生率比对照组低,差异显著(P0.05),具有统计学意义。结论通过对社区的高血压患者进行高血压健康教育能够加深患者对高血压的认识,有效降低和控制患者的血压,降低并发症的发生率。     

上海崇明县60岁以上人群对常见慢病的认知

目的 了解社区60岁及以上人群对慢性阻塞性肺疾病（慢阻肺）与高血压病、糖尿病、脑梗死等常见慢性病的整体认知情况,为制定社区老年人群常见的慢性病防治策略提供依据.方法 利用自设问卷询问参加社区体检的人群对慢阻肺、高血压病、糖尿病、脑梗死的高危因素、危害及防治方法等总体认知,将受慢病影响最大的60岁及以上人群作为分析对象.结果 60岁及以上人群共发放资料500份,资料完整合格者为428份.男189人,女239人.其中1.17％知晓肺功能检查,66.59％的人知晓血糖检查,68.93％的人知晓CT检查.仅1.87％的人知道慢阻肺疾病的名称,0.70％的人能基本正确知晓慢阻肺的高危因素、危害及防治知识.有92.52％的人表示知道高血压病的名称,能基本正确知晓高血压病高危因素、危害及防治知识的分别为25.70％、28.97％、28.97％.有85.28％的人表示知道糖尿病的名称,能基本正确知晓糖尿病高危因素的为23.13％,危害为19.86％,防治知识为18.93％.有80.61％的人表示知道脑梗死,能基本正确知晓脑梗死高危因素的为19.39％,危害为32.71％,防治知识为26.40％.对慢阻肺疾病名称的知晓率、危害因素、疾病的危害以及防治知识的知晓率均明显低于其他3种常见慢性疾病,差异有统计学意义（P＜0.01）.而在高血压病、糖尿病、脑梗死这3种疾病中,高血压病的推广普及工作较早,脑梗死的危害较重,其认知也高于对糖尿病的认知.结论 社区居民对慢阻肺及其相关知识的认知极低,居民对脑梗死,高血压,糖尿病的危害和防治知识知晓度也不高.今后应加强慢性病防治知识教育.     

社区老年人口服抗栓药物预防心脑血管疾病的现况与对策分析

目的分析北京某社区老年人口服抗栓药物进行心脑血管疾病一级预防和二级预防的应用现状。方法2019年10月至2020年3月期间在北京市翠微西里由社区医师通过标准问卷调查老年人的高血压、冠心病、糖尿病、脑梗塞、心房颤动等系统性疾病的患病情况和长期口服抗血小板聚集(APA)与抗凝(AC)药物治疗情况。结果328例老年人参与调查,其中158例(48.2%)长期口服抗栓药物治疗,144例(43.9%)口服APA药物,20例(6.1%)口服AC药物。罹患高血压、糖尿病、脑梗塞、冠心病的老年人仍未抗栓治疗比例分别为44.9%、45.0%、36.7%、8.1%。心房颤动患者AC治疗比例仅为50%,而与APA治疗患者的卒中风险和出血风险无差异。合并1或2种疾病的老年人占大多数(约占26.2%或28.7%),但其抗栓治疗比例仅为29.3%~61.7%。结论社区医师仍需加强对老年人抗栓治疗的教育,特别是罹患疾病较少的患者;房颤患者抗凝治疗亟待提高。     

农村社区高血压伴心理疾病患者个体化心理干预的临床效果观察

目的了解个体化心理干预对伴心理疾病的农村社区高血压患者的临床效果。方法将经SCL-90测评判定伴有心理疾病的农村社区高血压患者1125例随机分为心理干预组（干预组）562例和对照组563例。对照组按高血压防治指南要求予常规管理;心理干预组在同对照组常规管理的基础上进行个体化心理干预,6个月后统计疗效。结果心理干预组临床治疗效果（以血压下降为主要评判标准）总有效率为97．0％,对照组为67．3％,两组比较差异有统计学意义（P〈0．01）。干预组心血管事件发生率为1．8％,对照组为5．7％,两组比较差异有统计学意义（〈0．05）。干预组SCL-90测评判定伴有心理疾病的人数下降比对照组明显,差异有统计学意义（P〈0．01）。结论心理干预可使伴心理疾病的农村社区高血压患者的血压达标率明显升高,生活质量明显改善。     

Implementation of a community‐based hypertension control program in Matanzas,Cuba

Increased blood pressure is a leading risk factor for death worldwide, and improving the control of hypertension is a major health goal to reduce non‐communicable disease. Thus, in 2016, as part of a regional effort between the Pan American Health Organization and Cuban Ministry of Public Health to reduce cardiovascular risk and disease, a community demonstration project was implemented to enhance hypertension control. The intervention project was in a population of 25 868 people served by the Carlos Verdugo Martínez Polyclinic in Matanzas, Cuba. The project implemented interventions currently recommended in the World Health Organization HEARTS modules, including a standardized clinical training program with certification for blood pressure measurement, routine screening for hypertension in clinics and in the community, a simple directive pharmacologic treatment algorithm, and a registry with performance reporting and feedback. Qualitative and quantitative program monitoring and evaluation was established. In a 2010 national survey, the prevalence of hypertension and the rate of hypertension control were estimated to be 31% and 36%, respectively. Following less than one year of the full implementation of the program, the prevalence of hypertension, proportion of the hypertensive population registered as having hypertension, proportion of those drug‐treated who were controlled, and estimated population rate of control were 30%, 90%, 68%, and 58%, respectively. Based on these positive results, the program has been expanded to include another demonstration program initiated in a second region. In addition, preliminary efforts to disseminate and scale‐up aspects of the program to the full Cuban population have started.     

Management of older patients with hypertension in primary care: improvement on the rule of halves

OBJECTIVES: the benefits of treatment of hypertension in older people are well-established but implementation of this knowledge may be sub-optimal. We have determined recent primary care management of older people with hypertension. METHODS: we examined health records (n = 6986) of a 1 in 7 sample of patients aged 65-80 years from a random sample of practices (n = 51) in the former Northern Region of the UK, stratified by health authority, for the previous 6 years. We recorded documented risk factors, diagnosis of hypertension, three most recent blood pressure readings, current drug therapy and previous blood pressure lowering therapy, and presence of coexistent pathology. RESULTS: blood pressure was defined as hypertensive (> or = 160/> or = 90 mmHg; one or both values above these limits), normotensive or undetermined using a validated algorithm. In 30% of patients, blood pressure status was undetermined. Thirty-five percent of subjects were found to be hypertensive. Of these, 70% were receiving antihypertensive treatment but only 30% of treated patients had controlled (< 150 and 90 mmHg) and 13% well controlled (< 140 and 85 mmHg) blood pressure. In all, 14% of older hypertensive patients were detected, treated and had their hypertension controlled. There were significant differences between practices in the proportion of hypertensive patients treated (P < 0.001) and in the proportion of hypertensive patients whose blood pressure was controlled (P < 0.01). CONCLUSIONS: treatment of hypertension in older people in primary care has improved in terms of detection and treatment but in only one-third of patients is high blood pressure controlled. There remain important opportunities for prevention of stroke and myocardial infarction in this age group through achieving improved blood pressure control.     

Influence of arterial hypertension on diabetic retinopathy

The influence of arterial hypertension on the prevalence of diabetic retinopathy was evaluated by a cross-sectional study in 882 diabetic patients of whom 337 were insulin-treated and 505 were non insulin-treated. Arterial hypertension was defined by blood pressure values higher than 160-90 mmHg. Retinopathy was considered to be present when at least 2 microaneurysms were observed at the posterior pole. When duration of the diabetes was taken into account the prevalence of retinopathy in hypertensive subjects (69%) was not significantly higher than in normotensive subjects (47%) among the insulin-treated patients. However among non insulin-treated patients retinopathy was significantly more frequent in hypertensive (39%), than in normotensive subjects (25%; p less than 0.05).     

广州茶涪街社区高血压病的发病率、知晓率及治疗依从性研究

目的 了解广州市荔湾区茶涪街社区高血压病的发病率、知晓情况及依从性,为进一步做好高血压病的预防提供资料。方法随机抽取该社区住户中年龄≥20岁的居民2420名（社区总人口的8．77％）,给予问卷调查并测量血压。判定高血压的标准为：收缩压≥140mmHg和（或）舒张压≥90mmHg。判定单纯收缩期高血压的标准为收缩压≥140mmHg且舒张压〈90mmng。结果该社区20岁以上人员高血压病的发病率为16．12％,其中58．72％的高血压患者没有认识到自己患有高血压。在既往确诊病例中,70．19％的患者对降压治疗无良好的依从性。单纯收缩期高血压的发病率为4．71％。年龄≥60岁的高血压病患者中有43．56％为单纯收缩期高血压。结论广州市荔湾区茶涪街社区高血压病高发。有超过一半的高血压患者对自己患有高血压病不知晓。在老年高血压患者中,单纯收缩期高血压患者不少。大部分患者依从性差,仅少部分患者可将血压控制在理想水平。在社区内定期对居民血压进行普查并进行宣教是必要的。     

Anti-tuberculosis drug resistance in community and prison patients, Orel Oblast, Russian Federation.

SETTING: Orel Oblast, Russian Federation. OBJECTIVES: To determine baseline levels of anti-tuberculosis drug resistance in Orel Oblast. DESIGN: Drug susceptibility testing (DST) records from 1 July 1999 to 30 June 2000 for patients with sputum acid-fast bacilli smear-positive pulmonary tuberculosis were reviewed. Treatment and incarceration status were obtained from the tuberculosis register. Patients with 1 month or less of prior treatment were defined as new cases; those previously treated for more than 1 month were defined as retreatment cases. RESULTS: Of 246 smear-positive isolates, 212 (86%) had DST performed. Of these, 190 (90%) were from new and 22 (10%) from retreatment cases; 171 (81%) were from community and 41 (19%) were from prison patients. Any drug resistance was more common among prison than community patients (44% vs. 30%, P = 0.05). MDR-TB was found in 14 (6.6%) of 212 isolates, and was more prevalent in prison compared with community patients (12% vs. 5%, P = 0.05). Retreatment cases were more likely than new cases to have MDR-TB (prevalence ratio [PR] = 8.5, 95%CI = 3.3-22.3), although the PR was higher for prison than for community retreatment cases (10.0 vs. 5.8). CONCLUSIONS: New cases with MDR-TB were less prevalent in Orel Oblast compared with other survey sites in Russia. Any drug resistance and MDR-TB were associated with prior treatment, especially in the prison population. Continued monitoring of trends in drug resistance following DOTS implementation is needed.     

Critical analysis of the response to antihypertensive therapy. Report of 102 cases

One hundred and two patients with mild to moderate hypertension, non responding to a placebo therapy, were given an antihypertensive drug for a mean period of 6 weeks (range: 3-12 weeks). Their blood pressure (BP) was measured before and after active treatment by both a mercury manometer at the clinic and an ambulatory apparatus (Spacelabs 5200 or 90202). The clinic BP figures were poorly correlated with the 24 hour ambulatory BP levels, as well as the magnitude of decrease in clinic BP with the reduction in ambulatory BP. Twenty eight patients who were considered as "clinic responders" had in fact not significantly lowered their ambulatory DBP and, conversely, 16 patients were "clinic non responders" whereas they were "ambulatory responders". The patients were divided into 2 groups, according to White's and Morgan Roth's recommendations: group I (n = 61) with a percentage of pathological DBP readings (greater than 90 mmHg) during daytime as high as 50% or more, and group II (n = 41) with a percentage less than 50%. The correlations between the 2 methods of BP measurement were closer within the group I than within the group II and the rate of discrepancies between the "clinic" and "ambulatory responders" was lower. On the other hand, we identified the group II patients as being often "clinic responders" but rarely "ambulatory responders", whereas the inverse trend was observed in the group I. In conclusion: even in non placebo responding hypertensive patients the clinic BP measurement might be not sufficient for proper evaluation of an antihypertensive drug.(ABSTRACT TRUNCATED AT 250 WORDS)     

影响上海延吉地区的老年高血压病人治疗状况的研究

目的 了解老年高血压病人的治疗状况,分析影响病人就诊的主要原因,为采取针对性的有效措施提供依据。方法 对上海延吉地区16岁及16岁以上55566人进行问卷调查形式确定高血压者治疗本病情况。结果 60及60岁以上为19295人,高血压5842人,高血压患病率30．3％;16－59岁为36172人,高血压患病人数3536人,高血压患病率9．7％。老年组的未治疗率为3．1％,非老年组高达8．8％,规则治疗率则呈显相反趋势,分别为56．2％对73．3％。多因素分析结果显示影响治疗状况的独立因素为年龄、疾病严重程度、性别。（P＜0．01）。结论 当高血压病人在病情较重、年龄较大时才去作规则治疗不利减少高血压对靶器官损害。在中青年人群中开展高血压知识的宣传,对业已发现的病人进行及时规划治疗,是降低高血压严重后果的一项重要措施。