天津市北辰区高血压综合干预和持续管理效果评价

目的 采用综合干预手段评价天津市北辰区高危人群及高血压人群规范化持续化管理效果。方法随机抽样法抽取天津市北辰区35～75岁常住居民1 500名研究对象，先进行基线调查。根据调查结果，按照高血压分级管理将其分为一般人群、高危人群、高血压人群。通过给予综合干预措施包括：开展健康教育和健康促进，优化生活方式，指导规律性用药，控制危险因素等进行为期3年追踪随访，分析干预前后对高血压知识了解程度、高血压防治态度、行为改变、检测与高血压发生相关指标变化。结果与干预前（30.87%）相比，干预后对高血压诊断标准了解程度提升到59.60%，差异有统计学意义（2=11.25，P<0.05）；危险因素了解程度上在家族史、吸烟、饮酒、肥胖、饮食习惯（高脂、多盐）显著高于干预前，差异有统计学意义（P<0.05）；冠心病、心脏病高血压并发症了解程度显著高于干预前（P<0.01）。治疗手段了解程度上：与干预前相比，长期监测血压与青年期防治了解程度上显著高于干预前（P<0.05）。生活方式与干预前相比，干预后低糖饮食、低盐饮食、低脂饮食及定期监测血压方面显著升高，差异有统计学意义（P<0.05）。而在吸烟、饮酒、控制体重、参加锻炼方面与干预前相比较，差异无统计学意义（P＞0.05）。高血压发生相关指标，与干预前相比，高危人群中收缩压、舒张压和LDL-C显著降低（P<0.05），HDL-C水平显著升高（P<0.05）；高血压人群中收缩压、舒张压、LDL-C水平明显降低（P<0.05）。对干预前后北辰区居民对高血压防治态度进行比较分析。与干预前相比（有必要预防54.73%，接受宣传55.33%，改变不良嗜好52.90%，愿意参加健康教育44.80%），干预后（有必要预防70.51%，接受宣传91.16%，改变不良嗜好76.10%，愿意参加健康教育89.50%）均明显升高，差异有统计学意义（P<0.05）。结论实施高血压综合干预措施能加强社区对高血压诊疗意识，降低高血压发生风险，有效控制血压水平。

Comprehensive intervention and continuous management of hypertension in Beichen District of Tianjin

Objective To evaluate the effect of standardized and sustainable management of high-risk population of hypertension and hypertension population in Beichen District of Tianjin by comprehensive intervention. Methods Random cluster sampling method was used to select 1 500 permanent residents aged 35-75 in Beichen District of Tianjin. According to the results of the investigation, they were divided into general population, high risk population and hypertension population. Health education and health promotion, optimization of lifestyle, guidance of regular medication, control of risk factors and other follow-up were performed for a period of 3 years by comprehensive intervention measures. The knowledge of hypertension, the attitude of prevention and treatment of hypertension, the change of behavior and the change of indexes related to hypertension before and after intervention were analyzed. Results Compared with before intervention the level of understanding of the diagnostic criteria of hypertension after intervention was significantly higher (30.87% vs. 59.60%,X²=11.25, P<0.05). The awareness rates of family history, smoking, drinking, obesity, and eating habits (high fat and salt) on hypertension were significantly higher than those before intervention (P<0.05); So were the awareness on coronary heart disease, heart disease and hypertension complications (P<0.01). Compared with before intervention, the understanding of long-term monitoring of blood pressure and prevention and treatment in youth was significantly higher than that before intervention (P<0.05). Compared with before the intervention, the lifestyle with low sugar diet, low salt diet, low fat diet and regular monitoring of blood pressure were significantly more prominent after intervention (P<0.05). However, there was no significant difference in smoking, drinking, weight control or exercise compared with before intervention (P<0.05). Compared with before the intervention, the systolic blood pressure, diastolic blood pressure and LDL-C were significantly reduced in high-risk population after intervention (P<0.05); while the level of HDL-C was significantly increased (P<0.05). After the intervention, the residents of Beichen District had a significantly positive attitude to hypertension prevention and treatment (P<0.05). Conclusion Comprehensive intervention of hypertension could strengthen community awareness of hypertension diagnosis and treatment, reduce the risk of hypertension, and effectively control blood pressure level.