强化干预对社区中老年高血压或伴有脂代谢异常人群心血管事件的作用

Intensive intervention on cardiovascular events in community-dwelling elderly with hypertension or complicated by abnormal lipid metabolism

目的了解强化干预对社区中老年高血压或伴有脂代谢异常人群心血管事件(CVD)的影响。方法采用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。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43.5个月,记录CVD发生情况。结果随访43.5个月后,单纯高血压患者及高血压伴血脂异常患者干预组和对照组收缩压和舒张压均较干预前明显降低(P<0.01);两组CVD合计43例(4.0%),患有高血压者明显高于非高血压患者(6.9%vs2.9%,χ2=9.004,P=0.003,OR值2.492,95%CI 1.349-4.601);(3)干预组无论高血压或非高血压者CVD均明显低于对照组(其中2χ=4.729和6.822,和P=0.03和0.009,OR值2.645和3.438,95%CI为1.006-6.562和1.296-9.118)。结论高血压是社区中老年人CVD的高危因素,强化干预或普通干预均可明显降低社区高血压患者及伴有脂代谢异常人群血压水平。强化干预改变多重风险因子的作用较非强化干预能够更多的减少社区中老年人CVD的发生。

Objective To investigate the influence of intensive intervention on cadiovascular disease（CVD） in community-dwelling elderly with hypertension or complicated by abnormal lipid metabolism.Methods A cluster sample of 1 215 subjects from 2 different communities in Nanning city were randomly categorized into intensive intervention group and control group.The intensive intervention group received different treatment regimens according to the corresponding disorders,and the control group kept normal medical situation,including seeking medical advice and taking medicine voluntarily.After 43.5 months follow-up,CVD occurrence were recorded.Results After 43.5 months follow-up,the systolic and diastolic blood pressure decreased significantly in both intensive intervention group and control group（P0.01）.There were a total of 40 cases（4.0%） who developed CVD in both groups,among them,there were more patients with hypertension than without hypertension（6.9% vs 2.9%,（χ2=9.004,P=0.003,OR = 2.492,95%CI 1.349-4.601）.There were less patients who developed CVD in intensive intervention group than in control group（χ2=4.729 and 6.822,P=0.03 and 0.009,OR=2.645 and 3.438,95%CI 1.006-6.562 and 1.296-9.118）.Conclusion Hypertension is a high-risk factor in community-dwelling elderly;both the routine and intensive intervention can significantly decrease the blood pressure of the cases of hypertension or those complicated by abnormal lipid metabolism.Compared with the non-intensive intervention,the intensive intervention can more effectively reduce the occurrence of CVD in community-dwelling elderly.