卒中专病门诊随访对卒中患者高血压治疗率和达标率的影响

Effection of Special Clinic Follow-up on Hypertension Treatment and Optimal Hypertension Control rates in Stroke Patients

目的通过卒中专病门诊登记随访,提高对卒中患者高血压的管理。方法选择资料完整的、连续的在卒中专病门诊登记的伴高血压的卒中患者833例,按能否坚持在专病门诊随访分为两组,比较两组患者高血压的治疗率和达标率。结果833例患者中,随访后高血压的治疗率和达标率分别从随访前的40.5%和18.2%提高到92.1%和57.4%(P<0.01)。其中门诊随访患者的治疗率和达标率分别从41.0%和20.7%提高到98.4%和65.9%,电话随访患者的治疗率和达标率分别从39.0%和11.5%提高到74.3%和33.5%(P<0.001)。随访后患者联合使用降压药的比例从21.7%提高到28.8%(P=0.013),患者清淡饮食(48.3%到74.7%)、保持每日活动(17.3%到58.8%)、每周测血压(24.7%到46.7%)比例显著增加(P均<0.01),戒烟率(76.5%到94.4%,P<0.01)和戒酒率(77.1%到88.8%,P=0.002)亦显著增加。结论卒中专病门诊可以提高卒中患者高血压的治疗率和达标率,提高生活方式的改变。坚持专病门诊随访者较未能坚持者的高血压的治疗率和达标率更好。

Objective To improve the management of hypertension in hypertensive stroke patients by stroke clinic follow-up. Methods 833 serial stroke patients with hypertension were enrolled in the study and were divided into two groups according to their follow-up status. The percentages of the patients that were treated by antihypertensive therapy as well as the percentages of the patients with optimal hypertension control were compared between two groups. Results Compared with the baseline, the rates of hypertension treatment and the optimal hypertension control were increased signifi cantly during follow-up periods (from 40.5% to 92.1% and from 18.2% to 57.4%, respectively, P<0.01). Separately, the rates of hypertension treatment and the optimal hypertension control were signifi cantly increased in the patients that were followed up in the stroke clinic from 41.0% to 98.4% as well as from 20.7% to 65.9% (P<0.01) .Meanwhile, those rates were also signifi cantly increased in the patients that were telephone but not clinic followed up from 39.0% to 74.3% and from 11.5% to 33.5%(P<0.01). During the follow-up periods, the rate of combination therapy increased from 21.7% to 28.8% (P=0.013), as well as the rates of the patients with diet control(48.3% to 74.7%, P<0.01), keeping daily exercise(17.3% to 58.8%, P<0.001), keeping regular blood pressure measurement(24.7% to 46.7%, P<0.01), giving up smoking(76.5% to 94.4%, P<0.01), and drinking (77.1% to 88.8%, P=0.002)were increased signifi cantly. Conclusion Stroke clinic follow-up can improve the hypertension management and life style changing among hypertensive stroke patients. The rates of antihypertensive treatment and the optimal hypertension control were better in those followed up in the special stroke clinic than those not in the clinic.