大连湾地区农村原发性高血压患者降压药使用及血压控制情况

Application of decompression drugs and control of blood pressure in patients with essential hypertension from countryside of Dalianwan area

目的:了解大连湾农村地区原发性高血压患者用药及血压控制情况,为该血压预防和控制奠定数据依据。方法:①选择2003-01-01/12-31大连市甘井子区大连湾地区医院内科门诊就诊的高血压患者261例,均对检查及调查项目知情同意。②根据高血压危险度将患者分为3组:低危组(n=33):Ⅰ～Ⅱ级,无危险因子,无靶器官损害;中危组(n=77):Ⅰ～Ⅱ级+1～2个危险因子;高危及高危以上组(n=151):Ⅲ级并存有1或3个以上危险因子或靶器官损害和/或糖尿病(并发症);Ⅰ～Ⅱ级伴有心血管并发症。③测量患者血压,测量时详细询问病史,包括年龄、性别、高血压病史、口服药物种类、联合用药情况、血压控制情况、合并症以及吸烟、饮酒史等。行常规心电图、血脂、血糖、肾功能检测。血压控制水平判定标准为显效[舒张压下降≥10mmHg(1mmHg=0.133kPa),且降至正常范围(≤90mmHg)或舒张压下降≥20mmHg以上],有效[治疗后舒张压下降虽未达到10mmHg,但达到正常或收缩压下降≥20mmHg],无效(未达到上述标准)。有效率=(显效例数+有效例数)/用药总例数;控制率=显效例数/用药总例数。结果:原发性高血压患者261例均进入结果分析。①药物应用情况:261例患者中,185例患者进行药物降压治疗,治疗率70.9%;其中联合用药(两种或两种以上)25例(13.5%)和160例(86.5%)。高危及高危以上组、中危组、低危组中分别有130例(70.3%),44例(23.8%),11例(5.9%)患者服用降压药物治疗。降压药物中,以复方制剂处方率最高,占76.2%,其中复方降压片117例,降压O号24例;钙拮抗剂24例(13.0%);再次为血管紧张素转换酶抑制剂0例(5.4%);最后为β受体阻滞剂5例(2.7%);另外一些中成药5例(2.7%);185例用药患者中,163例患者使用单一降压药物,两种药物联合应用19例,只有3例应用3种降压药物。②血压控制情况:应用降压药物治疗的185例患者中显效14例(7.6%),有效165例(89.2%),无效6例(3.2%),有效率96.8%,控制率7.6%。结论:大连湾农村地区高血压服药品种比较单一,血压控制率不高。

AIM： To study the medication and control of blood pressure in patients with essential hypertension from countryside of Dalianwan area, and provide data for prevention and control of blood pressure. METHODS： ① 261 patients with hypertension, who were treated at the out-patient clinic of Department of Internal Medicine of Hospital of Dalianwan Area of Ganjingzi District of Dalian City between January and December 2003. They agreed to take part in the examination and investigation. ② According to the risk of hypertension, the patients were assigned into 3 groups： Low risk group （n=33）： Ⅰ - Ⅱ grade, no risk factor or target organ injury; middle risk group （n=77）： Ⅰ - Ⅱ grade ＋ 1-2 risk factors; high risk and above high risk group （n=151）： Ⅲ grade with 1 or over 3 risk factors or target organ injury and/or diabetes （complication）; Ⅰ -Ⅱ grade with complication of cardiovascular disease. ③ When blood pressure of the patients was measured, the history was demanded in detail, including age, sex, history of hypertension, class of orally taken drug, associated medication, control of blood pressure, complication, smoking and drinking, etc. Routine ekectrocar diogram electrocardiograph （ECG）, blood lipid, blood glucose and renal function were detected. Standard of control of blood pressure was apparently efficient effect [reduction of diastolic pressure ≥10 mm Hg （1 mm Hg=0.133 kPa）, and decreased by normal range （≤90 mm Hg） or over ≥ 20 mmHg], efficient effects [Diastolic pressure decreased after treatment, did not reach 10 mm Hg, but reached normal or systolic pressure decreased ≥20 mm Hg], and inefficiency （did not reach the above mentioned standard）. Effectiveness was equal to （cases with ap- parent efficiency ＋ cases with efficient effect）/total number of patients who taking medicine; Control rate was equal to cases with apparent efficiency/ total number of patients who taking medicine. RESULTS： 261 patients with essential hypertension were all involved in the result analysis. ① Drug application： Among the 261 patients, 185 patients were treated with decompression therapy with drug, with 70.9% treatment rate; including 25 patients with associated medication （two kinds or over two kinds） （13.5%） and 160 patients （86.5%）. There were 130 patients （70.3%）, 44 patients （23.8%） and tt patients （5.9%） in the high risk and above high risk group, middle risk group and low risk group, respectively, who took decompression drug, in which the compound prescription had highest utility rate, occupying 76.2%, including 117 patients taking compound decompression pill, 24 patients with decompression O number and 24 patients treated with calcium antagonists （13.0%）; Followed by 0 patients 5.4% treated with angiotensin converting enzyme inhibitor （ACEI）; Finally, 5 patients treated with β receptor blocker （2.7%）, and 5 patients treated with some Chinese medicine （2.7%）; Among the 185 medication patients, 163 patients were with single drug, 19 patients with two associated drugs and only 3 patients with three kinds of drugs. ② Control of blood pressure： Among the 185 patients that applied decompression drug, 14 patients had apparent effectiveness （7.6%）; 165 patients had effective effects （89.2%）; Six patients had inefficiency （3.2%）. The effectiveness rate was 96.8%, and the control rate was 7.6%. CONCLUSION： Variety of medication taken by patients with hypertension from the countryside of Dalianwan area is simple, and the control rate of blood pressure is not high.