综合强化干预对血压影响的纵向随访研究 社区人群心脑血管事件前瞻性研究系列之九

Effects of strengthen intervention of community groups in Nanning city blood pressure with longitudinal follow-up study

目的了解药物综合干预对社区高血压人群血压及心脑血管事件的影响。方法采用随机整群抽样南宁市两个社区的1215人为研究对象,随机分成强化干预组和对照组。强化干预组按照是否患有高血压及其相关疾病分别采取不同的强化治疗方案进行干预;对照组人员维持志愿就诊和志愿服药的正常医疗状态,随访3年,记录发生心脑血管事件。结果前瞻性随访研究43.5个月后①两组高血压患者收缩压和舒张压较干预前明显降低(P<0.01),其中干预组高血压患者收缩压较对照组下降程度更明显(P<0.05)。②两组高血压患者血糖较干预前明显降低,尿酸均较干预前增高,干预组体重、空腹胰岛素、BMI和LDL较干预前明显下降,而腰围、胆固醇和甘油三酯干预1.5后下降但3年后又有所反弹;对照组体重、腰围、胆固醇和甘油三酯下降不明显。③两组高血压控制率较干预前明显升高(P<0.01),且干预组高血压控制率明显高于对照组(P<0.001),两组高血压新发率逐年降低,但无统计学差异(P=0.054)。④本组人群心脑血管事件发生率为4.0%,高血压明显高于非高血压者(6.9%VS2.9%,P=0.003)。其中对照组无论高血压或非高血压者均明显高于干预组(P<0.001或P<0.05)。结论综合强化干预可明显降低社区高血压人群血压及相关代谢异常水平,减少高血压新发率,降低心脑血管事件发病风险。

Objective To understand the impact of blood pressure and the cardiovascular-cerebrovascular events through comprehensive drug intervention of community hypertension groups. Methods We used a random cluster sampling of Nanning City in line with the two communities included in the standard 1215 as an integrated intervention in the treatment of subjects,which were randomly divided into strengthening intervention and control groups.Strengthen the intervention groups which according to whether or not people suffer from hypertension and related diseases,were taken to strengthen the different treatment intervention;in the control group remained voluntary medical staff and volunteers taking care of the normal state,follow up 3 years to the CVD events. Results The forward-looking follow-up study after 43.5 months①as compared with the two groups of hypertension patients with systolic and diastolic blood pressure significantly lower than the pre-intervention.（P〈0.01） ;and the intervention group patients with systolic blood pressure than the control group declined even more significantly（P〈0.05）;②to compare with pre-intervention blood glucose significantly lower and uric acid higher than those; the weight,fasting insulin,BMI and LDL of intervention group more significantly decreased than pre-intervention;and waist circumference,cholesterol and triglycerides decreased after the intervention of 1.5 years,but rebound after 3 years;the weight,waist circumference,cholesterol and triglyceride of control group,decrease not obvious. ③the blood pressure control rate of both two groups significantly higher than before the intervention （P〈0.01）;and the intervention group was significantly higher than the control group （P〈0.001）,the two new hypertension rates go down year by year,but there is no significant difference on statistics （P=0.054）. ④the rate of cardiovascular-cerebrevascular events on this study was 4.0 percent, which of hypertension patients was significantly higher than those of non-hypertension （6.9% VS 2.9%,P=0.003）.Among the control group,whether hypertension or non-hypertension the rates are significantly higher than the intervention group （P〈0.001 or P〈0.05）.Conclusion Comprehensive drug intervention can significantly decrease blood pressure,and related groups metabolic levels of community hypertension group,reduce the incidence of new hypertension and the risk of cardiovascular-cerebrovascular events.