35岁以上社区居民高血压患病率及总体心血管事件危险分析

Morbidity and total cardiovascular events risk analysis in hypertensives more than 35 years old among a community residents

目的:了解社区人群高血压患病情况,并进行总体心血管事件危险分析,为高血压分级管理提供依据。方法:按《国家基本公共卫生服务规范》(2009年版)居民健康档案健康体检项目要求进行社区检查,并以2009年基层版《中国高血压防治指南》为标准定义各种危险因素、亚临床靶器官损害和临床疾患及相关技术指标,对高血压患者依据血压水平和心血管危险因素进行总体心血管危险分层。结果:35岁以上居民体检1 143人,发现高血压420人,轻中度高血压占大多数(34.56%),重度高血压占2.19%,高血压前期比例较高(22.48%)。单纯收缩期高血压占体检人数的9.19%。高血压的知晓率46.67%,治疗率29.59%,控制率17.24%。高血压患者不同危险因素显示年龄、腹性肥胖、早发心血管病家族史的患病率高。根据420例高血压患者血压水平分层:低危285例(67.86%),中危110例(26.19%),高危25例(5.95%)。添加现存的危险因素或靶器官损害或临床疾患再进行危险分层:低危11例,2.62%;中危30例,7.14%;高危379例,90.24%,高血压高危患者比例明显增加(添加后90.24%与添加前5.95%比较,P<0.01)。结论:本组资料中35岁以上社区居民高血压患病率高,知晓率、治疗率、控制率低,高血压的社区管理仅仅根据患者血压水平进行分层,低估了高血压人群中的高危患者,添加现存的危险因素或靶器官损害或临床疾患再进行危险分层提高了高危患者检出率。心血管危险因素对高血压患者总心血管危险分层有着决定性的影响,治疗策略应根据初始危险分层进行。

Objective： To investigate the hypertension situation in a community,and analyze the total cardiovascular risk in hypertensive patients among community,and then provide basis for hypertension classification management.Methods： Physical examination was made in a community according to the healthy check-up project requirement for inspection from residents health records on the basis of the national basic public health service rules（2009 edition）.Risk factors,subclinical organ damage（SOD）,clinical diseases and related technical indicators were based on chinese hypertension guidelines（Grassroots version）.All patients were stratified not only by grade of hypertension but also their total cardiovascular risk factors.Results： Among the 1 143 people examed,and 420 hypertensives were found.Low and moderate hypertensives made up to 34.56%,high level hypertensives took up 2.19%,while the proportion of prehypertension was 22.48%.Isolated systolic hypertension accounted for 9.19% of this physical examination.The rates of awareness,treatment and control were 46.67%,29.59%,17.24% respectively.Age,abdominal obesity and family history of premature cardiovascular disease were popular among the risk factors in hypertensives.Based on the levels of hypertension,patients were classified as follows： 67.86% at low cardiovascular risk,26.19% at moderate cardiovascular risk,5.95% at high cardiovascular risk.Risk factors,organ damage,clinical diseases added to stratification： 11 hypertensives,2.62% at low cardiovascular risk;30 hypertensives,7.14% at moderate cardiovascular risk;379 hypertensives,90.24% at high cardiovascular risk.The proportion of patients at high risk increased remarkablely（90.24% vs 5.95%,P0.01）.Conclusions： Hypertension morbidity more than 35 years old in this data in community residents is high,and awareness,treatment,control rates are low.Stratification only based on the levels of hypertension in the management of hypertensives among people beyond 35 years old in a comunity devalue the high cardiovascular risk.Stratification,risk factors,subclinical organ damage,clinical diseases added up,inhance the proportion of hypertensives at high cardiovascular risk.Total cardiovascular risk facts have a decisive affection when stratifying individual patients based on levels of blood pressure.As for decisions on treatment strategies,all depend on initial level of risk.