门诊高血压患者22 399例就诊情况分析

目的分析高血压患者在首都医科大学附属复兴医院（三级医院）门诊各科室就诊的数量、分布情况、用药情况以及药费金额。方法利用“东华医院信息系统”（MEDTRAK HIS系统）门诊医生工作站收集复兴医院2007年7月26日～2008年1月31日6个月以来门诊各科室收治22 399例高血压患者的性别、年龄、血压分级等就诊资料及用药情况、药费金额。将患者就诊科室分为普通内科组、心血管内科组、非内科专业组三个组，根据医院门诊药房备药情况将降压药物分为β受体阻滞剂、α体阻滞剂、血管紧张素转换酶抑制剂（ACEI）血管紧张素受体拮抗剂（ARB）、钙拮抗剂、利尿剂、中成药、传统复方降压药物8类。分析三组患者血压分级、年龄、性别等一般资料，不同类型降压药物使用情况及药费金额之间的差异。结果在门诊就诊的女性高血压患者多于男性患者（53．77％vs46．33％），心血管内科组高血压3级患者明显多于普通内科组及非内科专业组（P〈0．001），其西药费次均金额亦最高[296．75（177．30～436．20）]，而其中成药次均金额最少[0．00（0．00—70．43）]。在非内科专业组中，中成药次均金额多于西药费（P〈0．001）。在普通内科组与非内科专业组中处方量最大的前三种降压药物依次为：钙拮抗剂、β受体阻滞剂、ACEI，心血管内科门诊处方量最大的降压药物依次为：β受体阻滞剂、钙拮抗剂、利尿剂。结论心内科医师更多地在指南范围内选择降压药物，心血管内科组中成药在降压治疗中使用量明显少于普通内科组及非内科专业组。目前在复兴医院β受体阻滞剂仍作为一线降压药物被使用。     

门诊患者抗高血压药应用分析

目的:了解门诊患者抗高血压药的使用情况。方法:查阅我院2010年10月门诊应用抗高血压药的处方,对其用药种类、剂量及联用情况等进行统计分析。结果:我院抗高血压药量最常应用的依次为钙通道阻滞剂、β-受体阻滞剂及血管紧张素Ⅱ受体阻滞剂。抗高血压药应用频度(DDDs)前3位的是硝苯地平缓释片、氨氯地平及缬沙坦,药物利用指数(DUI)均≤1。约50%采用联合应用进行降压治疗,以钙通道阻滞剂+β-受体阻滞剂最多。结论:应用药物基本合理。注意合并用药之间的相互作用。     

贵阳市省直机关干部高血压患病危险因素分析

本文旨在探讨贵阳市省直机关干部高血压患病的危险因素，为贵阳市省直机关干部制定相应的干部保健措施提供科学依据。 1资料和方法 1．1一般资料2005年贵阳市省直机关干部安排在我院进行健康体检，共检查7994例，其中男5370例（67．18％），女2624例（32．82％），年龄28—92岁，     

我国高血压专病门诊患者血压控制及糖代谢调查现状分析

目的 探讨高血压专病门诊就诊的高血压患者血压控制率、血糖现状和危险因素分布.方法 在全国127家医院的高血压专病门诊采用横断面调查的方法,对门诊顺序入组的32 004例高血压患者开展病史询问、血压测量及生化血检查,并进行统计学检验分析.结果 (1)血压达标率(＜ 140/90 mm Hg)(1 mm Hg =0.133 kPa):全部人群达标率为26.8％.冠心病、糖尿病、肾病和卒中的达标率分别为27.7％、30.0％、25.4％和21.3％.(2)接受调查的全部受试者的血压均值为(151 ±13)/(92±10)mm Hg,未服用降压药物3424例(10.7％).药物治疗者28 580例(89.3％).单药治疗19 818例(69.3％),联合用药治疗8762例(30.7％),使用最多的药物是肾素血管紧张素系统抑制剂,其次为钙通道阻滞剂.(3)高血压患者中有70.3％存在糖代谢异常,仍有20.2％未服降糖药物,这组患者糖化血红蛋白为7.84％.(4)患者的危险分层:低、中危占16.0％,高危和极高危分别占48.0％和36.0％,其中有50.0％患者存在不同程度与靶器官损害,49.0％患者并存其他临床疾病.结论 高血压患者中联合治疗的比例较低并是血压控制不良的原因之一,血压控制率不足30％；高血压患者中糖代谢异常普遍存在,有更多靶器官损害及临床疾病,有效的血压管理势在必行.     

肺原性高血压34例临床分析

肺原性高血压３４例临床分析曹美云江苏省常熟市第一人民医院（２１５５００）笔者根据Мухарламов提出的有关肺原性高血压（ＬＨ）的诊断与治疗，对我院１９９４～１９９６年三年间收住的１８６例慢性阻塞性肺部疾患（ＣＯＰＤ）患者中符合ＬＨ特征的３４例分析...     

门诊患者高血压知信行调查

高血压是引起心脑血管、肾脏疾病的重要危险因素,早期预防比高科技的医疗手段更为有效.因此,慢性病预防如高血压的预防等健康知识都是门诊患者急需的.     

高血压长处方联合医院-社区综合管理治疗高血压的分析

目的 分析高血压长处方联合医院-社区综合管理治疗高血压的临床效果。方法 将100例长处方治疗高血压患者按数字随机表法分为两组,即对照组50例,运用常规管理;观察组50例,在对照组干预基础上运用医院-社区综合管理;对比两组患者血压控制水平、用药依从性及生活方式改善程度。结果 观察组干预后血压达标率（96.00%）高于对照组（78.00%）,血压水平低于对照组,服药依从性高于对照组,干预后生活方式改善程度明显高于对照组（P<0.05）。结论 高血压长处方联合医院-社区综合管理用于高血压管理,有利于血压控制,提高患者服药依从性,临床应用意义高。     

顽固性高血压76例诊治分析

原发性高血压患者在使用包括一种利尿剂在内的足量的三种药物治疗后仍未能达到目标血压，被称为顽固性高血压（refractory or resistant hypertension，RH），而这组患者又是引起高血压人群严重并发症和死亡的最危险组分，应引起高度关注。     

288例临界高血压12年预后分析

对汉中288例年龄30～60岁农民临界高血压患者随访12年。结果显示，转归确诊高血压者1．6％，仍维持临界高血压者27．2％，血压恢复正常者41．2％。临界高血压伴年龄偏大、高血压家族史、体重指数偏高或心率偏快者转归确诊高血压危险性增大。     

高血压专科3706例住院继发性高血压患者病因构成分析

目的分析2012-2016年河南省人民医院高血压科住院高血压患者9439例中继发性高血压患者3706例病因分类及构成比较,为高血压防治提供病因学参考。方法采用回顾性研究方法,分析9439例住院高血压患者中3706例继发性高血压患者年龄、性别构成及病因分类。结果9439例住院高血压患者中原发性高血压占60.74%(5733例),继发性高血压占39.26%(3706例)。在继发性高血压患者中,心理因素性高血压例数最多(1175例,31.70%),其次例数较多的是阻塞性睡眠呼吸暂停低通气综合征(779例,21.02%)、原发性醛固酮增多症(728例,19.64%)、肾血管性高血压(702例,18.94%)。与原发性高血压患者相比,心理因素性高血压、原发性醛固酮增多症、肾血管性高血压、甲状腺功能减退症、青光眼患者年龄较大,心理因素性高血压、内分泌性继发性高血压的女性患者较多(P<0.05)。与原发性高血压患者相比,继发性高血压患者的年龄[(50.2±15.0)比(46.6±15.2)岁]较大、男性患者比例[54.6%(2024/3706)比64.5%(3695/5733)]较小(均P<0.05)。继发性高血压和原发性高血压患者中女性的平均年龄高于男性(P<0.05)。结论2012-2016年高血压住院患者中继发性高血压占39.26%,高于国内外文献报道。住院的高血压患者心理因素性高血压比例居于首位,阻塞性睡眠呼吸暂停低通气综合征、原发性醛固酮增多症、肾血管性高血压的比例也较高。年龄较大的高血压患者中也筛查出不少继发性高血压。     

氨氯地平治疗22例原发性高血压病的疗效观察

应用按氯地平治疗原发性高血压病22例，每日一次给药，治疗2周后．血压下降，有效率81．8％，（P＜0．01），治疗4周后有效率94．4％，（P＜0.01）．服药前后心率变化无临床意义（P＞0.05），长期服用无耐药性．副作用少，且服用方便．作用温和，单用或与其他降压药物合用均有效。     

Cost-Effectiveness of Improved Hypertension Management in India through Increased Treatment Coverage and Adherence: A Mathematical Modeling Study

Background:Despite the availability of effective and affordable treatments, only 14% of hypertensive Indians have controlled blood pressure. Increased hypertension treatment coverage (the proportion of individuals initiated on treatment) and adherence (proportion of patients taking medicines as recommended) promise population health gains. However, governments and other payers will not invest in a large-scale hypertension control program unless it is both affordable and effective.Objective:To investigate if a national hypertension control intervention implemented across the private and public sector facilities in India could save overall costs of CVD prevention and treatment.Methods:We developed a discrete-time microsimulation model to assess the cost-effectiveness of population-level hypertension control intervention in India for combinations of treatment coverage and adherence targets. Input clinical parameters specific to India were obtained from large-scale surveys such as the Global Burden of Disease as well as local clinical trials. Input hypertensive medication cost parameters were based on government contracts. The model projected antihypertensive treatment costs, avoided CVD care costs, changes in disability-adjusted life year (DALYs) and incremental cost per DALY averted (represented as incremental cost-effectiveness ratio or ICER) over 20 years.Results:Over 20 years, at 70% coverage and adherence, the hypertension control intervention would avert 1.68% DALYs and be cost-saving overall. Increasing adherence (while keeping coverage constant) resulted in greater improvement in cost savings compared to increasing coverage (while keeping adherence constant). Results were most sensitive to the cost of antihypertensive medication, but the intervention remained highly cost-effective under all one-way sensitivity analyses.Conclusion:A national hypertension control intervention in India would most likely be budget neutral or cost-saving if the intervention can achieve and maintain high levels of both treatment coverage and adherence.     

国家基层高血压防治管理指南2020版

心血管疾病已成为我国首位死亡原因,管理好高血压患者是遏制我国心脑血管疾病流行的核心策略之一。基层医疗卫生机构通过国家基本公共卫生服务项目对高血压患者进行长期随访管理,本指南旨在为基层医务人员提供高血压防治管理的简单直接的操作指导。在2017版基础上,基于政府部门的管理要求和新近发布的相关领域研究证据,本指南主要在高血压的基层管理、血压测量、降压目标值以及降脂治疗目标值等内容上进行了更新。此外,首次增加了中医药在高血压领域的应用相关内容,为基层医务人员在高血压管理方面提供更全面的指导。     

Impaired glucose metabolism and obesity in Swedish patients with borderline isolated systolic hypertension: Skaraborg Hypertension and Diabetes Project

Summary
Aim   To assess the prevalence of borderline isolated systolic hypertension (borderline ISH), and to examine its association with other cardiovascular risk factors.
Methods   A cross-sectional community-based study was carried out in 1993–1994 in Skara, Sweden, including 1109 randomly chosen subjects ≥ 40 years old. Normotension (NT) was defined as systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg, borderline ISH as SBP 140–159 and DBP < 90 mmHg and hypertension (HT) as SBP ≥160 or DBP ≥ 90 mmHg or ongoing treatment.
Results   The prevalence of borderline ISH (n = 203) by age was 4% in ages 40–49 years, 15% in ages 50–59 years, 28% in ages 60–69 years and 25% in ages 70–79 years. With borderline ISH as reference, normotensive subjects less often had fasting blood glucose > 5.5 mmol/l (odds ratio (OR): 0.4, 95% CI: 0.26–0.75), BMI > 27 kg/m² (OR: 0.6, 95% confidence intervals (CI): 0.42–0.85) and known diabetes (OR: 0.4, 95% CI: 0.16–0.95). Hypertensive subjects more often had high density lipoprotein (HDL) cholesterol < 1.0 mmol/l (OR: 2.0, 95% CI: 1.35–2.99), a history of previous cardiovascular disease (CVD) (OR: 1.7, 95% CI: 1.01–2.72), known diabetes (OR: 2.4, 95% CI: 1.29–4.58) and microalbuminuria (men) (OR: 1.9, 95% CI: 1.15–3.11).
Conclusion   Borderline ISH is a common condition. It is associated with a more unfavourable risk factor profile than that of normotensive subjects concerning primarily glucose metabolism and obesity. The prevalence of known diabetes increased with the degree of hypertension.     

498例社区门诊2型糖尿病血糖控制状况及原因分析

目的 总结2型糖尿病病人在社区门诊治疗中临床特点,分析血糖控制效果差的原因。方法 对2001年1月至2006年12月期间,本社区门诊符合1999年WHO2型糖尿病诊断标准的糖尿病病人,在治疗过程中血糖控制不良的498例,采用询问病情、随访等方法,加以总结并作原因分析。结果 血糖控制不良的主要相关因素是：1．未行有效生活方式干预。2．不愿接受药物治疗。3．未按医嘱服药并自我规范监测血糖。4．当单一药物无效时拒绝联合用药。5．单一中药治疗。6．拒绝胰岛素治疗。结论 目前本社区门诊糖尿病血糖控制不佳者约26．51％。社区医生应加强对糖尿病的卫生宣教,坚持规范治疗,提高患者医从性。     

Hypertension,cholesterol and diabetes medication adherence,health care utilization and expenditure in a Medicare Supplemental sample

Limited evidence exists regarding the relationships between adherence, as defined in Pharmacy Quality Alliance (PQA) medication adherence measures, health care utilization, and economic outcomes. PQA adherence measures for hypertension, cholesterol, and diabetes are of particular interest given their use in Medicare Star Ratings to evaluate health plan performance.The objective of this study was to assess the relationship between adherence and utilization and cost among Medicare Supplemental beneficiaries included in the aforementioned PQA measures over a 1-year period.Retrospective cohort study.Three cohorts (hypertension, cholesterol, and diabetes) of eligible individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009–2015) were used to assess associations between adherence and health care expenditure and utilization for Medicare Supplemental beneficiaries.Generalized linear models with log link and negative binomial (utilization) or gamma (expenditure) distributions assessed relationships between adherence (≥80% proportion of days covered) and health care utilization and expenditure (in 2015 US dollars) while adjusting for confounding variables. Beta coefficients were used to compute cost ratios and rate ratios.Adherence for all 3 disease cohorts was associated with lower outpatient and inpatient visits. During the 1-year study period, adherence was associated with lower outpatient, inpatient, and total expenditures across the cohorts, ranging from 9% lower outpatient costs (diabetes cohort) to 41.9% lower inpatient costs (hypertension cohort). Savings of up to $324.53 per member per month in total expenditure were observed for the hypertension cohort.Our findings indicate adherence is associated with lower health care utilization and expenditures within 1 year.     

Parental Obesity Combined with Hypertension—an Indicator of Excess Risk of Hypertension in Offspring

Abstract A case—control study was performed to estimate the excess risk of hypertension in a defined population. The study comprised 121 hypertensive patients, aged 40–59 years, and 138 non-hypertensive controls selected from the same primary care district. Parental obesity combined with hypertension proved to be a stronger risk indicator of hypertension in offspring than parental hypertension itself. Other risk indicators were obesity, hypertension in siblings and a positive family history of myocardial infarction. In order to study the size of the problem we estimated the prevalence of hypertension and borderline hypertension in the district. Patients with these diagnoses amounted to about one fourth of the middle-aged population in the district. More than 80% of the hypertensives had been diagnosed before this study, but only about 20% of the borderline hypertensives were previously known.     

Hypertension Management in Minority Communities: A Clinician Survey

BACKGROUND: Rates of blood pressure (BP) control are lower in minority populations compared to whites. OBJECTIVE: As part of a project to decrease health-related disparities among ethnic groups, we sought to evaluate the knowledge, attitudes, and management practices of clinicians caring for hypertensive patients in a predominantly minority community. DESIGN/PARTICIPANTS: We developed clinical vignettes of hypertensive patients that varied by comorbidity (type II diabetes mellitus, chronic renal insufficiency, coronary artery disease, or isolated systolic hypertension alone). We randomly assigned patient characteristics, e.g., gender, age, race/ethnicity, to each vignette. We surveyed clinicians in ambulatory clinics of the 4 hospitals in East/Central Harlem, NY. MEASUREMENTS: The analysis used national guidelines to assess the appropriateness of clinicians' stated target BP levels. We also assessed clinicians' attitudes about the likelihood of each patient to achieve adequate BP control, adhere to medications, and return for follow-up. RESULTS: Clinicians' target BPs were within 2 mm Hg of the recommendations 9% of the time for renal disease patients, 86% for diabetes, 94% for isolated systolic hypertension, and 99% for coronary disease. BP targets did not vary by patient or clinician characteristics. Clinicians rated African-American patients 8.4% (p = .004) less likely and non-English speaking Hispanic patients 8.1% (p = .051) less likely than white patients to achieve/maintain BP control. CONCLUSIONS: Clinicians demonstrated adequate knowledge of recommended BP targets, except for patients with renal disease. Clinicians did not vary management by patients' sociodemographics but thought African-American, non-English-speaking Hispanic and unemployed patients were less likely to achieve BP control than their white counterparts.     

Measuring the quality of hospital care: an inventory of indicators

Background: Development of indicators to measure health-care quality has progressed rapidly. This development has, however, rarely occurred in a systematic fashion, and some aspects of care have received more attention than others. The aim of this study is to identify and classify indicators currently in use to measure the quality of care provided by hospitals, and to identify gaps in current measurement.
Methods: A literature search was undertaken to identify indicator sets. Indicators were included if they related to hospital care and were clearly being collected and reported to an external body. A two-person independent review was undertaken to classify indicators according to aspects of care provision (structure, process or outcome), dimensions of quality (safety, effectiveness, efficiency, timeliness, patient-centredness and equity), and domain of application (hospital-wide, surgical and non-surgical clinical specialities).
Results: 383 discrete indicators were identified from 22 source organizations or projects. Of these, 27.2% were relevant hospital-wide, 26.1% to surgical patients and 46.7% to non-surgical specialities, departments or diseases. Cardiothoracic surgery, cardiology and mental health were the specialities with greatest coverage, while nine clinical specialities had fewer than three specific indicators. Processes of care were measured by 54.0% of indicators and outcomes by 38.9%. Safety and effectiveness were the domains most frequently represented, with relatively few indicators measuring the other dimensions.
Conclusion: Despite the large number of available indicators, significant gaps in measurement still exist. Development of indicators to address these gaps should be a priority. Work is also required to evaluate whether existing indicators measure what they purport to measure.