北京市东城区鼓楼地段高血压人群防治的效果评价

The Effect of Medical Treatment onHypertension Community Control A follow-up study of more than one thousand hyper- tensives in East City Proper, Beijing

高血压严重威胁人类健康，许多国家主张进行高血压管理，但就管理中治疗对改善高血压人群预后有何作用意见不一，此问题直接关系到高血压防治策略的制定。本文依据北京东城区鼓楼地段１９８２～１９８７年高血压随访管理资料，并借助计算机与地段疾病监测死亡资料相核对，比较不同服药病人心、脑血管病预后，探讨高血压人群治疗效果。通过对１９８２～１９８７年１２８９例高血压累计４２８３年次的年内服药及年内预后情况的观察，作粗分析、分层分析及Ｌｏｇｉｓｔｉｃ模型因素调整分析，结果虽提示治疗对改善Ⅲ期重型病人预后有益，但未发现对降低其他高血压人群脑卒中发病及死亡率、心血管病与总死亡率产生显著影响。本文按吸烟分层的分析还提示吸烟可能对抗高血压药物疗效有不利影响。基于本文结果，建议高血压社区管理仍应以目前公认为有益的健康教育来广泛宣传戒烟、适当运动、控制体重、合理膳食等多项活动为益，治疗则应视病人具体情况而定，不宜过分强调。

ypertension exerts a great threat on humanhealth.Al-though most of countries promotethe management of hypertension in communities, the role of treatment of hypertension is stillcontroversial, it directly influences the stra- tegy of hypertension community control. This study was based on the survey of essential andborderline hypertension in Gu-lon District ofEast City Proper,Bei jing in 1981,and the ma-nagement of 1339 hypertenives in the follow-up from 1982 to 1985, and the mortality registra- tion in the district by Disease Surveillance System. By observing the prognosis within oneyear among different treatment groups(nonusers, less than 9 months and more than 9 mon- ths within one year),1289 patients were fol- lowed up for a total of 4283 person-years. Crude analyses,stratified and logistic analyses with multi- variables adjustment of age,sex,blood pressure, with or without end-organdamage,etc.could not find that treatments had obvious effects on the reduction of incidence and mortality of stroke,mortality of CVD and all- cause in hypertensives except severe cases.The stratified analyses dy smoking also showed that smoking had a disad- vantageous effects for treated hypertensives. Based on our results, we suggest that health edu- cation should be a major part of hypertension management program in community; treatments of hypertension should consider the flexible situation of patients and may not be a priority in hypertension community control program.