深圳市中青年高血压患者心率和β-受体阻滞剂使用情况研究

背景　深圳市作为强劲发展的一线城市，快节奏的工作和激烈的竞争环境给中青年增加了很多压力，长期的压力会使个体的心率加快，导致血压升高。研究深圳市中青年高血压患者心率现状对有效开展高血压管理具有重要意义。目的　了解深圳市中青年高血压患者心率和使用β-受体阻滞剂的现状，为深圳市中青年高血压患者的防治提供依据。方法　2017年3—6月采用自行设计的问卷进行横断面调查，采用方便抽样法在深圳市9个行政区域内选取32家医院/社区健康服务中心，并方便抽选前来医疗机构就诊的高血压患者2 152例，最终进入分析的中青年高血压患者1 639例。调查患者的性别、年龄、既往史、血压、心率及服药情况。结果　1 639例中青年高血压患者平均心率为（81.0±11.0）次/min；血压达标610例（37.22%），血压不达标1 029例（62.78%）。血压达标者和血压不达标者血压、心率、合并冠心病、合并高脂血症、使用β-受体阻滞剂情况比较，差异有统计学意义（P<0.05）。Pearson相关分析结果显示，中青年高血压患者心率与收缩压之间存在线性正相关（r=0.411，P<0.001），心率与舒张压之间也存在线性正相关（r=0.455，P<0.001）。在血压控制不达标患者中，心率<80次/min患者与心率≥80次/min患者合并冠心病、糖尿病、高脂血症情况比较，差异有统计学意义（P<0.05）；与使用β-受体阻滞剂者相比，未使用者心率更快、收缩压更高、舒张压更高，差异有统计学意义（P<0.05）。血压不达标且使用β-受体阻滞剂的中青年高血压患者中，心率<80次/min的患者与心率≥80次/min者合并冠心病、糖尿病、高脂血症情况比较，差异有统计学意义（P<0.05）。结论　深圳市中青年高血压患者心率偏快，心率较高的中青年高血压患者易同时合并其他慢性病。为降低患者的并发症发生率和死亡率，应增强社区健康服务中心医生的心率管理意识，加强心率治疗指征、控制范围、药物选择、个体化治疗等相关的诊疗培训。

Heart Rate and β-blocker Use in Young and Middle-aged Hypertensive Patients in Shenzhen

Background Shenzhen,as a first-line city with rapid development,the fast-paced work and fierce competition environment increase a lot of pressure on young and middle-aged people.Long-term pressure will accelerate the heart rate of individuals leading to the rise of blood pressure.It is of great significance to study the heart rate of young and middleaged hypertensive patients for the effective management of hypertension in Shenzhen.Objective To understand the current status of heart rate and the use ofβ-blockers in young and middle-aged hypertensive patients in Shenzhen,in order to provide evidence for the prevention and treatment of hypertension in young and middle-aged people.Methods A cross-sectional survey was conducted using a self-designed questionnaire from March to June in 2017.Using convenience sampling method,32 hospitals/community health service centers were selected in 9 administrative districts of Shenzhen and a total of 2152 hypertensive patients were enrolled.Among them,1639 young and middle-aged hypertensive patients were included in this study.The survey included gender,age,past medical history,blood pressure,heart rate and medication situation of patients.Results The mean heart rate of 1639 young and middle-aged hypertensive patients was(81.0±11.0)beats/min,and 610(37.22%)of them with blood pressure up to standard and 1029(62.78%)of them with blood pressure not up to standard.There were significant differences in the blood pressure,heart rate,coronary heart disease,hyperlipidemia and use ofβ-blockers between the blood pressure up to standard group and blood pressure not up to standard group(P<0.05).Pearson correlation analysis showed that there was a linear positive correlation between heart rate and systolic blood pressure(r=0.411,P<0.001)and diastolic blood pressure(r=0.455,P<0.001).Among patients with blood pressure not up to standard,compared with those with heart rate<80 beats/min,the patients with heart rate≥80 beats/min had higher prevalence of coronary heart disease,diabetes and hyperlipidemia(P<0.05);compared with those who usedβ-blockers,the patients withoutβ-blocker use had faster heart rate,higher systolic pressure and diastolic pressure(P<0.05).Among young and middle-aged hypertensive patients who usedβ–blockers in the blood pressure not up to standard group,compared with those whose heart rate was less than 80 beats/min,patients with heart beats≥80 beats/min had a higher incidence of coronary heart disease,diabetes and hyperlipidemia(P<0.05).Conclusion The young and middle-aged hypertensive patients in Shenzhen have a fast heart rate,and those with faster heart rate are more likely to have other chronic diseases at the same time.In order to reduce the incidence of complications and mortality,doctors in community health service centers should enhance their awareness of heart rate management,and related diagnosis and treatment training of heart rate treatment indications,its control range,drug selection and individualized treatment should also be strengthened.