上海市社区老年单纯高血压与高血压合并糖尿病患者知信行模式比较

目的比较上海市社区老年单纯高血压与老年高血压合并糖尿病患者的高血压知信行模式。方法2011年5月至7月，以上海市徐汇区5个社区卫生服务中心纳入高血压规范化管理的47572例高血压患者为目标人群，进行简单随机抽样问卷调查，问卷内容包括患者基本资料、高血压知识知晓情况、高血压信念、高血压行为。共发放问卷3800份，回收有效问卷3328份，应答率87．6％。取其中的老年（≥65岁）单纯高血压患者及老年高血压合并糖尿病患者的数据进行分析。结果老年单纯高血压1057例和老年高血压合并糖尿病360例分两组纳入分析，男性分别占42．5％（449／1057）和41．7％（150／360），平均年龄（76．1±6．4）岁和（75．9±6．4）岁。老年高血压合并糖尿病组对“高血压是一种慢性病”（99．4％比96．5％，χ2=8．659，P=0．003）和“高血压患者应坚持长期服药”（98．9％比95．4％，χ2=8．898，P=0．003）的知晓率高于老年单纯高血压组。两组高血压知识均主要来源于社区全科医师门诊，但老年高血压合并糖尿病组中这一比例更高（75．9％比65．6％，χ2=12．913，P〈0．05）。两者中控制盐摄人的患者比例差异无统计学意义（88．3％比88．8％，P=0．799）；老年高血压合并糖尿病组每次运动时间较短（49±30）min比（53±31）min，t=3．362，P=0．001]，更“担心有心、脑、肾并发症”（12．0％比6．3％，）（χ2=12．144，P〈0．05），更倾向于选择三级医院作为主要就诊机构（20．2％比13．8％，χ2=7．832，P=0．005），其降压达标率明显低于老年单纯高血压患者（15．3％比79．2％，χ2=470．264，P〈0．05）。结论社区全科医师门诊是老年高血压患者获得高血压知识的主要途径，全科医生应针对不同人群采取相应的个体化健康教育模式及降压达标标准，尤其应加大对合并有糖尿病的老年高血压患者的教育力度。

Knowledge, attitudes, belief and practices in elderly hypertensive patients and hypertensive patients complicated with diabetes

Objective To compare the knowledge, attitudes, belief and practices （KABP） in elderly hypertensive patients and hypertensive patients complicated with diabetes mellitus （DM） in communities of Shanghai. Methods A cross-sectional study with simple random sampling was undertaken in 5 communities of Shanghai Xuhui District during May 2011 to July 2011. The target population were 47 572 patients incorporated into standardized management of hypertension. Total 3800 questionaires containing the basic information of patiens and their knowledge, attitudes, belief and practices on hypertension were distributed and 3328 were retrieved with a response rate of 87. 6%. The survey results of elderly （≥ 65 y ） hypertensive patients and hypertensive patients with DM were analysed and compared. Results Total 1057 elderly patients aged （76. 1 ± 6. 4 ）y had simple hypertension and 42. 5% （449/1057） were males; while 360 elderly hypertensive patients aged （75.9± 6. 4） y were complicated with DM and 41.7% （150/360） were males. The rates of awareness of ＂hypertension is a chronic disease＂ （99. 4% vs. 96. 5%, χ2 = 8. 659, P = 0. 003 ） and ＂hypertensive patients should persist in taking long-termmedications＂ （98.9% vs. 95.4%, χ2 = 8. 898, P = 0. 003 ） was higher in patients with complicated DM than those in simple hypertensive patients. Most of them received education on hypertension-related knowledge from community out-patient clinics, while the percentage of this resource was higher in patients with hypertension and DM （75.9% vs. 65.6%, χ2 = 12. 913, P 〈0. 05）. There was no statistical difference in controlling dietary salt intake between two groups （88. 3% vs. 88. 8%, P = 0. 799 ）. Patients with hypertension and DM had shorter excise time than patients with simple hypertension （49 ＋ 30）min vs. （53 ± 31 ） min, t = 3. 362, P = 0. 001 ], they were more likely to visit hypertension clinics （ 12. 0% vs. 6. 3%,χ2 = 12. 144, P 〈 0.05 ） and more frequently to seeking hypertension-related medical help from tertiary hospitals（20. 2% vs. 13.8%, χ2 =7. 832, P =0. 005）. The control rate of hypertension in patients complicated with DM was significantly lower than that in simple hypertensive patients （ 15.3% vs. 79.2%, χ2 = 470. 264, P 〈 0. 05 ）. Conclusions Community out-patient clinic is the main source of knowledge on hypertension for elderly hypertensive patients; so general practitioners should carry out individulized health education for blood pressure control, especially for those complicated with diabetes.