高血压患者社区综合防治疗效分析

目的对高血压患者实行社区综合防治,提高社区居民防病治病意识。方法采用建档管理、分级干预、健康教育的措施对354例高血压患者实施干预,并比较干预前后高血压病知识的知晓率、不良生活行为改变率进行干预前后的比较及效果评价。结果干预前后高血压患者控高行为、控高知识的知晓率、血压控制、不良生活行为明显改变。结论对高血压病患者实行分级管理,综合个体化干预后,可提高患者对自己疾病的知晓及重视程度,并增加其遵医行为,从而提高社区居民防病治病意识,对高血压病的预防及控制都起着积极的作用。     

农村社区高血压综合干预效果评价

目的评价社区综合干预对农村社区高血压病的效果。方法通过对3968例高血压患者建立健康档康、定期随访、健康教育、规范药物治疗等社区卫生综合干预,2年后进行干预效果评价。结果干预后,高血压患者的高血压知晓率、治疗率、控制率、规范服药率明显提高,高盐饮食和体育锻炼、饮酒情况有改善,但吸烟情况无显著变化。结论社区综合干预可以显著控制农村社区高血压患者的血压,改善高血压患者的不良生活习惯,提高患者的生活质量。     

高血压患者社区综合干预效果评估

目的 对社区高血压患者实施综合干预,并对干预效果进行评估.方法 对在社区卫生服务中心确诊的110例高血压患者进行为期一年的社区综合干预,包括健康教育、药物治疗、行为干预和定期随访,并且于干预前后对患者进行问卷调查和医学体检,评价其干预效果.结果 参加社区综合干预的高血压患者综合干预1年后,患者血压显著下降;高血压等相关慢性病知识知晓率有显著提高.患者的不良行为如饮酒、过量食盐、不规则服药、缺乏体力活动的人数与干预前相比具有统计学意义.结论 对高血压患者实施综合干预对血压控制、改善认知状况具有积极作用.     

高血压的预防及社区综合干预的效果观察

目的探讨高血压的预防及社区综合干预的效果。方法选取2012年我社区的高血压前期患者共180例,随机分为对照组和试验组,对照组给予常规干预措施,试验组给予健康教育、饮食干预、体质量控制、烟酒干预等综合干预措施,比较两组患者血压控制效果。结果试验组高血压控制总有效率为83.3%,高于对照组的58.9%,差异有统计学意义(P<0.05)。结论社区综合干预工作能有效控制高血压前期人群的血压,值得推广应用。     

番禺社区人群6年高血压综合防治效果评价

目的 探索经济迅速发展的珠江三角洲地区农村社区人群防治高血压的持续有效的途径和措施。方法 主要采用全人群策略和高危人群策略。措施包括：①高血压社区综合防治三级防治网的建立；②高血压抽样调查、全社区高血压病人检出及高危人群管理；③社区健康教育及基层医务人员培训。结果 全社区高血压健康知识有所提高，社区人群高血压治疗率和控制率分别从81．4％和44．8％提高到83．2％和46％，高血压患病率呈逐步下降的趋势，从1996年的11．4％下降至2000年的7．1％。结论 通过全人群策略和高危人群策略的高血压社区综合防治，在番禺社区切实可行，卓有成效。     

浅析质量控制在高血压社区综合干预中的作用

目的探讨质量控制在高血压社区综合干预中的作用。方法制定质量控制方案和流程,建立质量控制队伍,对质控员和社区医生进行分阶段、分层次的业务培训。采用网上抽查、电话问询、表格核对和现场督导等方式,对基线调查和随访阶段的血压、人体形态测量、表格填写、数据网络输入等重点环节进行质量控制。结果试点社区责任医生的业务水平和整体素质得到有效提高,调查表格填写的完整率、正确率和真实性显著上升,血压正确测量率由40.83%上升到90.10%,尾数偏爱现象明显减少,2周内体检和随访结果网络输入率上升至90%以上,随访率由35.21%提高到80.31%,个体化健康教育处方接收率75.23%,高血压病人的规律服药率由45.32%上升至76.32%,高血压病人的知晓率由26.52提高到95.32%,治疗率由29.14提高到80.62%,控制率由10.31%提高到61.12%,高血压社区综合干预成绩显著。结论质量控制是提升高血压社区综合干预效果的重要措施。     

上海某社区高血压人群社区干预调查

目的了解某社区高血压人群经过社区干预后的血压控制水平。方法问卷调查某社区有历史记录的高血压人群，并记录现时血压，与历史记录作对比分析。结果社区干预使血压高危人群平均舒张压下降15．5mmHg，平均收缩压下降23．3mmHg。结论高血压人群经过社区干预后，血压有所下降。     

《高血压社区综合干预信息化管理规范》实施效果

为了有效遏止高血压不断上升的趋势,减少心脑血管病的发病率、致残率和死亡率,绍兴市马山镇2005年列入《浙江省高血压社区综合干预信息化管理》试点以来,按照《浙江省高血压社区综合干预信息化管理规范》（以下简称《规范》）的实施要求,积极开展高血压社区综合干预工作,取得了显著成绩,现报告如下。     

高血压患者社区综合干预疗效观察

目的通过社区综合干预观察对高血压的控制疗效,并逐步探索高血压社区防控的新模式、新方法。方法首先进行社区高血压人群的筛查,选取明确诊断为原发性高血压的居民800例,随机分为干预组和对照组（非干预组）,两者除常规药物治疗外,前者还增加健康教育、定期巡诊、随访、纠正不良生活方式、制定健康运动方案等社区综合干预措施。两组均定期检查理化指标,进行干预前后对比。结果干预组除血压控制明显优于对照组外,其他诸如体质指数、血脂等指标良性改善也优于对照组。结论开展社区综合干预对高血压的防控效果显著,值得进一步推广,并需要长期、持续进行下去。     

高血压社区综合干预及其效果初探

近20年来高血压的发病率在我国几乎增加了一倍,由高血压引发的心脑血管疾病的死亡率已排到所有疾病死亡率的第一位。自2005年5月至2008年11月,我们下城区朝晖街道实行社区高血压分层分级综合干预,并实行信息化管理,取得了一定效果,现总结如下。     

Diabetes and Hypertension: Pathogenesis,Prevention and Treatment

Hypertension occurs in approximately 30% of patients with type 1 diabetes and from 50 to 80% of patients with type 2 diabetes. Although the pathogenesis of hypertension is distinct in each type, hypertension markedly enhances the already high risk of cardiovascular and renal disease in types 1 and 2 and implications for treatment are similar in both. The threshold for blood pressure treatment in diabetic patients is generally agreed to be 140/90 mm/hg with a target BP of < 130/80. So‐called “lifestyle modifications” play an important role in therapy, particularly in type 2 patients, by decreasing blood pressure and improving other risk factors for cardiovascular disease. Indeed non‐pharmacologic interventions have been demonstrated to prevent the development of type 2 diabetes in patients at high risk to develop the disease. Aggressive anti‐hypertensive drug treatment is warranted given the high risk associated with the combination of diabetes and hypertension and the demonstrated effectiveness of anti‐hypertensive treatment in reducing cardiovascular morbidity and mortality in this group of patients. ACE inhibitors and ARBs are the cornerstones of pharmacologic management, in no small part because of the renoprotective effects of these agents in antagonizing the development and progression of diabetic renal disease. Multiple agents, including diuretics, will usually be required to attain target blood pressure levels.     

高血压综合预防干预的效果:6年后果观察

目的提高原发性高血压临床疗效,减少或延缓并发症的发生。方法对一个学校教职工进行定期的统一问卷调查和健康体检、健康教育;对筛查出的高血压病人进行管理和个体化治疗;对高血压、心脑血管病发病危险因素进行干预;对治疗效果进行定期随访总结。结果6年来,该校高血压发病率逐年下降(从23.7%降到19.0%);高血压病人的知晓率、治疗率和控制率由第1年的49.5%、37.1%和19.6%升至6年后的94.4%、83.7%和82.4%(P均<0.01);高血压发病危险因素明显降低;心脑血管病的发病率和死亡率明显减少(P均<0.01)。结论对高血压患者进行综合干预,可积极有效地控制高血压,降低其并发症发生率,提高生活质量。     

Hypertension in Very Old Subjects

The role of hypertension as a risk factor for mortality and cardiovascular morbidity and the benefits of antihypertensive treatment are well established in older patients up to 80 years. For people aged 85 and over, who are the most rapidly growing segment of population in developed countries, data are scarce and conflicting. A positive association between blood pressure and survival has been found in several cohort studies, and this relation held true after adjustment for many factors. In randomized trials, the benefits of antihypertensive treatment declined with age and were not observable after 80 years, with the exception of the SHEP study. People who reach a very old age share some characteristics which make them different from the bulk of “60 (or 65) and over” and justify special studies which are currently in progress. In the meantime, any treatment decision can only rely on extrapolations moderated by common sense.     

社区高血压病控制现状的研究

为了解影响高血压病治疗率和控制率的因素,有效地控制心脑血管病的上升趋势,我们对北京大学社区的４９５例高血压病人进行了调查。研究发现：本组高血压病人中,受教育水平高、有家族高压病史、有合并症、了解正常血压标准者治疗率较高（Ｐ＜０．０５）。受教育水平高、高血压病程短、体重正常、食盐摄入较低、轻度高血压者、了解正常血压水平标准者控制率高（Ｐ＜０．０５）。经常自测血压,以血压值作为治疗依据者,其控制率最高。多因素分析结果与单因素分析相似。     

社区综合防治对高血压患者生活质量的影响

目的评价在社区实施综合防治对高血压患者生活质量及其血压控制效果的影响。方法对120例社区综合防治管理的原发性高血压患者采用问卷卷方式调查其生活质量指标,并检测其动态血压指标。比较实施前、后动态血压及生活质量的变化。结果实施社区综合管理前后高血压患者的合理膳食、坚持锻炼、定期检测、遵医用药卫生行为间差异有统计学意义（P〈0．01）。实施社区综合管理前后高血压患者的躯体感觉、认识功能、社会参与能力、生活满足感评分间差异均有统计学意义（P〈0．01）,睡眠状态管理前后差异无统计学意义（P〉0．05）。120例患者高血压的总有效率为87．5％。实施社区综合防治管理后高血压患者的24hSBP、24hDBP、dSBP、dDBP、nSBP、nDBP、SBP load及DBP load均有明显的降低,前后比较差异有统计学意义（P〈0．01）。结论社区综合防治管理对高血压患者实施的行为干预。在改善高血压患者行为生活方式、提高生活质量、提高其血压控制率等方面有积极作用。     

Hypertension as a risk factor for cardiovascular morbidity and mortality in an elderly German population; the prospective STEPHY II study. Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly.

AIM: To prospectively study the relationship between blood pressure levels and subsequent cardiovascular morbidity and mortality in a population aged 65 years and older. METHODS: Participants of the 1992 baseline survey of the population-based Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly (STEPHY, 394 men and 588 women above age 65) were followed up for 3 years. Total mortality was assessed by official death data. Cardiovascular morbidity, that is, the occurrence of non-fatal events (new cases of acute myocardial infarction, angina pectoris, stroke, and heart failure) could be assessed in 681 of the 863 survivors by a second interview and analysis of general practitioners' records. The mortality and morbidity risks were compared for hypertensives (baseline blood pressure > or = 160/95 mmHg or antihypertensive treatment) and non-hypertensives. RESULTS: During follow-up a total of 55 men and 64 women died resulting in a 2.7-year cumulative mortality in this population of 12%. Mortality was higher in men (14%) than in women (11%). Hypertensives had no increased risk of death compared to non-hypertensives (adjusted relative risk (RR)=0. 92; 95% CI: 0.48-1.76 for men and RR=1.36; 95% CI 0.67-2.78 for women). This was confirmed in age-stratified analyses. However, among survivors hypertension was associated with a significantly higher occurrence of non-fatal cardiovascular events. After controlling for potentially confounding baseline conditions, the relative risk for any event (RR=1.44; 95% CI: 1.04-2.0) and, in particular, of acute myocardial infarction (RR=5.5; 95% CI: 1.6-18. 7) was raised among hypertensives. Higher rates for angina pectoris (RR=1.4; 95% CI: 0.9-2.4) and heart failure (RR 1.7; 95% CI: 0.9-2. 9) were of borderline significance. Positive risk associations were confined to the age group 65 to 75 years and not detected at higher ages. CONCLUSION: This study demonstrates for a Central European population older than 65 years the impact of hypertension as a risk factor for cardiovascular and cerebrovascular morbidity. To address the issue that risk of death showed no significant relationship to blood pressure, a longer follow-up period might be necessary.     

Relationship Between Visceral Fat Accumulation and Hypertension in Obese Men

Purpose.?Visceral‐fat (VF) accumulation is suggested to be a major contributor to such cardiovascular‐disease risk factors as hypertension (H), glucose intolerance (G), and hyperlipidemia (L). We have devised a simple way of estimating VF accumulation, and investigated the relationship between VF and hypertension in obese men. Methods.?First, CT scan was used to measure VF area in the umbilical region in 108 obese men. Then the umbilical‐region circumference (C) was measured with a tape measure and abdominal skinfold thickness (S) with a skinfold caliper. The data obtained with a model formula (VF_e = αC² ? βCS + γ) and actual VF area were compared, and three coefficients, α, β, and γ, were calculated by means of multivariate analysis. Next, in 354 male company employees, VF_e was estimated using this model formula, and cardiovascular risk factors were investigated. Results.?The formula for estimating VF (cm²) was VF_e = 0.03C² ? 0.36CS ? 47 (correlation coefficient; r = 0.72). Discriminant analysis between the merely obese group (O) and the group complicated by multiple cardiovascular risk factors (O, H, G, and L) determined a VF_e‐cutoff value of 120 cm². Its discriminant sensitivity/specificity values were significantly higher than those based on body mass index (BMI) (cutoff value of 27 kg/m²) (p < 0.05). Hypertensive obese (HO) men with high VF_e value (>120 cm²) had a higher frequency of other risk factors (G or L: 86%). Conclusion. VF_e is considered useful in estimating VF accumulation, and seems more effective than BMI for predicting multiple cardiovascular risk factors (VF syndrome) in obese hypertensive men.     

浙江省杭州市西湖区高血压流行现状及危险因素分析

目的 了解浙江省杭州市西湖区居民高血压患病情况及其相关危险因素,为本区高血压病防治干预提供科学依据.方法 通过整群抽样的方式对西湖区8个社区年满35岁以上的居民入户进行问卷调查及相关体格检查,数据用Epidata3.1进行录入,SPSS 13.0进行统计分析.结果 杭州市西湖区人群的高血压患病率为46.5％,男性患病率显著高于女性(51.9％比41.3％;P ＜0.0001).该社区高血压的知晓率为70.2％,控制率为23.8％.随着年龄的增加,男性和女性的患病率均呈增高趋势(P ＜0.0001).与正常体质指数者相比,超重、肥胖患者的高血压患病率显著升高(51.5％和59.0％比36.1％;P ＜0.0001).Logistic回归分析显示,年龄、性别、饮酒、超重/肥胖、糖代谢异常及高甘油三酯是高血压的独立危险因素(P＜0.05).结论 杭州市西湖区居民高血压患病率处于较高水平,人群分布及相关危险因素具有一定的地域特征,高血压的预防控制应结合本地特点进行针对性干预.     

高血压家族遗传因素与心血管病危险因素聚集关系的研究

目的：探讨高血压遗传因素与心血管病危险因素聚集的关系。方法：采用家系调查方法，对比分析高血压家系和对照家系直系亲属的危险因素个体聚集性。共调查高血压家系２５个，含直系亲属１５８例，其中包括高血压患者５４例，血压正常者１０４例；对照家系１５个，含直系亲属６５人。结果：超重（体重指数＞２５ｋｇ／ｍ２），高甘油三酯（甘油三酯＞２．０ｍｍｏｌ／Ｌ），高尿酸血症（男：尿酸＞３７４．９ｍｍｏｌ／Ｌ；女：尿酸＞３１５．４ｍｍｏｌ／Ｌ），高胰岛素血症（胰岛素＞１２．２μｍｏｌ）及低高密度脂蛋白胆固醇（低高密度脂蛋白胆固醇＜０．９１ｍｍｏｌ／Ｌ）５个危险因素中，具有１个以上至５个以上上述危险者的年龄标化百分比在高血压家系明显高于对照家系，将高血压家系中高血压患者剔除后比较，这种规律依然存在。结论：高血压家族遗传因素可能对心血管病危险因素聚集起着重要的作用     

《中国高血压防治指南》在北京基层医师中实施的运行机制分析

目的:分析北京基层医师贯彻《中国高血压防治指南》(指南)的运行机制障碍,提出解决问题的建议和具体措施。方法:系统随机抽样调查指南在400名北京市城乡基层临床医师中的执行情况。结果:基层医师培训率为29.0%;向患者进行非药物治疗解释工作的医师比例为80.8%,城乡间差异有显著性(P<0.001);城乡继续教育的渠道不一,差异有显著性(P<0.001);62.8%的基层医师反映基层药物种类少;19.8%的基层医师接收过上级医院转诊的患者。结论:1.应改进对基层医师的培训方法和内容。2.基层医师非药物治疗指导方式有待提高。3.从教育形式和内容方面加强农村基层医师的继续教育。4.完善贯彻指南的激励机制。5.医疗保险体制改革应重视社区卫生服务站的降压药物种类使用的政策。6.进一步完善双向转诊制度以提高高血压患者管理的费效比。