我国职业场所高血压综合干预效果评价

目的 评价在职业场所开展高血压综合干预的效果。方法 采用整群随机对照设计，在全国选取20个分中心，每个分中心选取条件相匹配的2~4家职业场所，随机分为管理组和常规组。管理组采取职业场所心血管病一级预防和高血压患者规范化管理的综合干预策略，每位患者至少管理2年；常规组沿用现行管理办法，收集基线及2年时的资料。本研究对职业场所中入选的30家国企单位（管理组20家，常规组10家）高血压患者资料进行分析。主要指标为高血压控制率，干预效果为管理组差值（率/均值）-常规组差值（率/均值）。结果 共有2 622名患者完成2年随访，其中，管理组2 055人，常规组567人。实施综合干预后，与常规组相比，管理组患者SBP和DBP的干预效果分别为-7.5 mmHg和-3.9 mmHg（P<0.05），BMI为-0.4 kg/m²（P<0.05），规律运动率和饮酒率分别为36.4%和-14.0%（P<0.05），而吸烟率为-6.1%（P>0.05），血压控制率的干预效果为25.0%（P<0.05）。亚组分析显示高中文化程度（27.6%）、白领（41.9%）、属于医疗机构已分离企业（41.9%）的患者控制率干预效果更好（P<0.05）。结论 在职业场所开展高血压综合干预可显著改善高血压控制状况。

Effect of comprehensive intervention on hypertension control program in workplaces in China

Objective To evaluate the effect of comprehensive intervention program on hypertension control in workplaces in China. Methods The study design was a non-randomized controlled trial. First, 20 sub-centers were selected across China, then hypertension patients in 2-4 workplaces were selected as the intervention group, and hypertension patients in 1 comparable workplace selected, as the control group in each sub-center. The comprehensive intervention strategy which integrating workplace primary prevention of cardiovascular diseases and standardized management of hypertension was adopted in the intervention group for at least 2 years. Patients in the control group continued their usual health care, and only baseline data and 2-year data was collected. Analyses were conducted for hypertension patients in 30 stated-owned enterprises (SOEs), including 20 for the intervention group and 10 for the control group. The primary outcome was the control rate ofhypertension while the intervention effect (IE) was estimated by using the formula:differential value of intervention group[rate (mean)]-differential value of control group[rate (mean)]. Results Overall, 2 622 patients completed the 2-year follow-up, of which 2 055 were in the intervention group and 567 in the control group, respectively. After 2 years of intervention, the IE on the level of SBP and DBP for intervention group and control group were -7.5 and -3.9 mmHg, respectively (P<0.05). BMI decreased by 0.4 kg/m², with the regular exercise rate as 36.4% and alcohol consumption rate decreased by 14.0%, respectively (P<0.05). The smoking rate decreased by 6.1% (P>0.05). The overall hypertension control rate was 25.0%, and further subgroup analysis showed that our intervention program was particularly effective for those with high education level (27.6%), white-collar employees (41.9%), and those from SOEs whose affiliated hospital had been separated away (41.9%). Conclusion The comprehensive intervention program could greatly improve the hypertension control in the workplaces in China.