云南省基本公共卫生服务管理的高血压患者合并症现状分析

目的 了解云南省基本公共卫生服务管理的高血压患者合并症现状及其影响因素，为后续针对性干预措施提供科学依据。方法 于2021年采用分层多阶段随机抽样，抽取云南8个县区接受基本公共卫生服务管理的1 181例35岁及以上高血压患者作为研究对象。通过问卷调查、体格检查和实验室检测，收集糖尿病、脑卒中、冠脉疾病、慢性肾脏病、心力衰竭等高血压合并症信息，分析高血压合并症在性别和居住地中的分布，采用多因素logistic回归的分析方法对高血压合并症的影响因素进行分析。结果 1 181例高血压患者中合并症282例（23.9%）；其中糖尿病占72.6%。单因素结果显示:汉族患合并症的风险高于其他民族（χ2=14.536，P＜0.001）、每天平均静态时间≥6 h高于＜6 h（χ2=5.323，P=0.021）。服用降压药（χ2=11.386，P=0.003）、体力活动不足（χ2=5.339，P=0.021）、腹型肥胖（χ2=19.682，P＜0.001）及血脂异常者（χ2=27.539，P＜0.001）患合并症风险更高。多因素logistic回归分析结果发现:与男性相比，女性是患合并症的保护因素（OR=0.725, 95%CI:0.539～0.976），年龄≥65岁（OR=2.045, 95%CI:1.014～4.126）、汉族（OR=1.648, 95%CI:1.184～2.294）、血脂异常（OR=1.882, 95%CI:1.415～2.502）、用1种（OR=1.379, 95%CI:1.003～1.897）和≥2种降压药（OR=1.637, 95%CI:1.075～2.494）、腹型肥胖（OR=1.904, 95%CI:1.402～2.586）、平均静态时间≥6 h（OR=1.524, 95%CI:1.075～2.160）是患合并症的危险因素。结论 本研究高血压患者合并症检出率为23.9%，需要继续完善基本公共卫生服务的管理及相关合并症防控。

Analysis of the current status of comorbidities in hypertensive patients managed by basic public health services in Yunnan Province

Objective To investigate the current status and influencing factors of comorbidities in patients with hypertension under the management of basic public health services in Yunnan Province, and to provide a reference for subsequent targeted interventions. Methods By using stratified multi-stage random sampling in 2021, 1 181 hypertensive patients aged 35 and over were selected from 8 counties and districts in Yunnan. Through questionnaire, physical examination, and laboratory examination, the information of hypertension comorbidities including diabetes, stroke, coronary artery disease, chronic kidney disease and heart failure were collected, and the distribution of hypertension complications in gender and residence was analyzed. Logistic regression analysis was used to analyze the influencing factors of hypertension complications. Results Among the 1 181 patients with hypertension, 282 cases (23.9%) had comorbidities, of which diabetes accounted for 72.6%. The univariate results showed that the risk of comorbidities in Han ethnic group was higher than that in other ethnic groups (χ2=14.536, P<0.001), and the risk was higher in people having average daily static time of ≥ 6 h than those < 6 h (χ2=5.323, P=0.021). Antihypertensive drugs (χ2=11.386, P=0.003), insufficient physical activity (χ2=5.339, P=0.021), abdominal obesity (χ2=19.682, P<0.001), and abnormal blood lipids (χ2=27.539, P<0.001) were associated with higher risk of comorbidities. Multifactorial logistic regression analysis revealed that women was a protective factor for comorbidity compared with men (OR=0.725, 95%CI: 0.539-0.976), while age ≥65 years (OR=2.045, 95%CI: 1.014-4.126), Han ethnicity (OR=1.648, 95%CI: 1.184-2.294), dyslipidemia (OR=1.882, 95%CI: 1.415-2.502), use of one antihypertensive drug (OR=1.379, 95%CI: 1.003-1.897) and ≥2 antihypertensive drugs (OR=1.637, 95%CI: 1.075-2.494), abdominal obesity (OR=1.904, 95%CI: 1.402-2.586), and meantime at rest ≥6 h (OR=1.524, 95%CI: 1.075-2.160) were risk factors for developing comorbidities. Conclusion The detection rate of comorbidities in hypertensive patients in this study was 23.9%, and it is necessary to continue to improve the management of basic public health services and the prevention and control of related comorbidities.