三种管理模式对老年高血压患者血压、血脂、心血管事件影响的多中心研究

Multi-center study of three managements to blood pressure,lipid,cardiovascular events in elderly patients with hypertension

目的探讨健康管理减少老年高血压患者心血管事件风险的效果。方法选择本院2008年6月～2009年6月收治的老年高血压患者160例,将其随机分为健康管理组(53例)、药物管理组(53例)、对照组(54例),对照组患者入院时给予常规用药指导及健康教育,药物管理组在对照组基础上给予用药监督及调整;健康管理组根据个人情况制订个性化健康管理方案,从健康教育、生活方式干预、用药指导、心理干预四个方面进行综合健康管理,并监督实施,随访2年,观察患者生活习惯、血压、血脂等指标改善情况和心血管事件情况,并进行组间比较。结果健康管理组患者随访2年内心血管事件发生率低于药物管理组,药物管理组低于对照组,三组间比较,差异有统计学意义(P<0.05);干预后三组收缩压、舒张压均降低,健康管理组和药物管理组脉压降低,对照组脉压略微升高。健康管理组收缩压、脉压低于对照组(t=3.934、4.021,P<0.05),且收缩压低于药物管理组(t=3.267,P<0.05),药物管理组脉压低于对照组(t=2.791,P<0.05)。三组干预后三酰甘油、低密度脂蛋白均下降,高密度脂蛋白升高,健康管理组低密度脂蛋白、三酰甘油明显低于对照组(t=5.719、4.361,P<0.05),药物管理组低密度脂蛋白明显低于对照组(t=4.015,P<0.05)。结论老年高血压患者系统的健康管理可以明显减少心血管事件发生率,改善血脂和血压,效果优于常规的药物治疗及健康教育。

Objective To investigate the effect of health management in reducing cardiovascular events in elderly patients with hypertension.Methods 160 cases of elderly hypertensive patients in our hospital from June 2008 to June 2009 were randomly divided into health management group（53 cases）,medication management group（53 cases）,control group（54 cases）.Patients of control group were given conventional medication guide and health education.Patients of medication management group were given medication the monitoring and adjustment on basis of control group.The patients of health management group were given personalized health management according to their personal situation including four aspects of health education,lifestyle guidance,medication guidance,psychological intervention,and implementation situation was supervised.All patients were given 2-year follow-up to observe the situation of life habits,blood pressure,lipids and other indicators.Results The cardiovascular events of health management group were less than medication management group,and events of medication management group were less than control group in 2-year follow-up,the difference was statistically significant（P〈0.05）;SBP,DBP of three groups all declined,pulse pressure（PP） of health management group and medication management group declined too,but the pulse pressure of control group slightly increased.SBP,PP of health management group was lower than that of control group（t = 3.934,4.021,P〈0.05）,and SBP was lower than medication management group（t = 3.267,P〈0.05）;PP of medication management group was lower than that of control group（t = 2.791,P〈0.05）.TG,LDL of three groups all decreased,HDL increased,but LDL,TG of health management group was significantly lower than that of control group（t = 5.719,4.361,P〈0.05）,LDL of medication management group was lower than that of control group（t = 4.015,P〈0.05）.Conclusion The health management can significantly reduce the incidence of cardiovascular events in elderly patients with hypertension,and the effect is better than conventional drug treatment and health education.