上海社区高血压疾病细节管理对高血压患者血压和血脂的影响研究

Effects of Disease Details Management Program for Hypertension on Blood Pressure and Serum Lipid of Hypertensive Patients in Shanghai Community

目的评价社区高血压疾病细节管理对高血压患者血压和血脂控制的效果。方法资料来自上海市区4个社区的现场调查,共招募1 442例符合心血管危险分层属于中危层或高危层的原发性高血压病患者,其中男性占36.27%,女性占63.73%;中危层患者占82.39%,高危层患者占17.61%。采用自动生化分析仪测定血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-c)和低密度脂蛋白胆固醇(LDL-c)水平。非药物干预包括加强社区医生和高血压患者间的沟通,通过讲座和资料发放传播高血压防治知识和技能。结果与日常管理组比较,干预后细节管理组的收缩压和舒张压净下降6.75 mm Hg和4.29 mm Hg(P<0.001);血清TG和TC明显下降(t=4.249,P<0.001;t=2.231,P=0.026);血清HDL-c和LDL-c没有明显变化(P>0.05)。结论社区高血压疾病细节管理不但可以降低高血压患者的血压水平,而且有助于血脂的改善,特别是TG和TC水平。

Objective To evaluate the effectiveness of disease details management program on control of blood pressure and blood lipid for hypertensive patients in communities. Methods Totally 1 442 primary hypertension patients（males accounting for 36.27% and females for 63.73%） who,according to risk stratification,belong to moderate-risk（accounting for 82.39%） and high-risk（accounting for 17.61%） from 4 communities in Shanghai were enrolled.The serum levels of triglyceride（TG）,total cholesterol（TC）,high density lipoprotein cholesterol（HDL-c）,and low density lipoprotein cholesterol（LDL-c） were measured by automatic biochemical analyzer.Non-pharmacological intervention included enhancing communication between community physicians and patients,and population of knowledge and skills of hypertension control through lectures and materials on health. Results Comparing with the conventional group,in the details management group the net decreases of systolic and diastolic blood pressure were 6.75 and 4.29 mm Hg respectively after the intervention（P0.001）.And the serum TG and TC levels were significantly decreased（t=4.249,P0.001;t=2.231,P=0.026）.But no statistically significant change was found in serum HDL-c and LDL-c levels（P0.05）. Conclusion The disease details management for hypertension in community can help blood pressure control for hypertension patients,but also improve blood lipid,especially serum TG and TC.