我国高血压专病门诊患者血压控制及糖代谢调查现状分析

Blood pressure SUNNing-ling＊ 100044, China control and glucose metabolism status in hypertension specialty clinics in China

【摘要】目的探讨高血压专病门诊就诊的高血压患者血压控制率、血糖现状和危险因素分布。方法在全国127家医院的高血压专病门诊采用横断面调查的方法，对门诊顺序入组的32004例高血压患者开展病史询问、血压测量及生化血检查，并进行统计学检验分析。结果（1）血压达标率（〈140／90mmHg）（1mmHg=0．133kPa）：全部人群达标率为26．8％。冠心病、糖尿病、。肾病和卒中的达标率分别为27．7％、30．0％、25．4％和21．3％。（2）接受调查的全部受试者的血压均值为（151±13）／（92±10）mmHg，未服用降压药物3424例（10．7％）。药物治疗者28580例（89．3％）。单药治疗19818例（69．3％），联合用药治疗8762例（30．7％），使用最多的药物是肾素血管紧张素系统抑制剂，其次为钙通道阻滞剂。（3）高血压患者中有70．3％存在糖代谢异常，仍有20．2％未服降糖药物，这组患者糖化血红蛋白为7．84％。（4）患者的危险分层：低、中危占16．O％，高危和极高危分别占48．0％和36．0％，其中有50．0％患者存在不同程度与靶器官损害，49．0％患者并存其他临床疾病。结论高血压患者中联合治疗的比例较低并是血压控制不良的原因之一，血压控制率不足30％；高血压患者中糖代谢异常普遍存在，有更多靶器官损害及临床疾病，有效的血压管理势在必行。

Objective To investigate blood pressure control the glucose metabolism, cardiovascular risk factors of patients who were regularly followed up at professional hypertension clinics in China. Methods A cross-sectional survey was conducted in 32 004 patients from 127 professional hypertension clinics across China The questionnaires included case history and related treatment physical examination and laboratory biochemical tests were also taken at the same time. Results The mean blood pressure of overall population was （ 151 _＋ 13）/（92 -＋ 10） mm Hg（ 1 mm Hg = 0. 133 kPa）. Totally 3424 patients （ 10. 7% ） had never taken any anti-hypertension medicine. Among patients treated with anti-hypertension drugs, 19 818 were of mono-therapy （69. 3% ） and 8762 were of combination therapy. The most frequently used drug was renin- angiotensin system inhibitor, followed by calcium-channel blocker. Fixed compound preparations accounted for 15.6%. The overall blood pressure control rate （ 〈 140/90 mm Hg ） was 26. 8%, among them, 27. 7%, 30. 0%, 25.4% and 21.3% patients were complicated with coronary heart disease, diabetes mellitus, kidney diseases and cerebral stroke respectively. About 70. 3% hypertensive patients had abnormal glucose metabolism whose mean glycosylated hemoglobin （GHbAlc） was 7.84%, which was significantly higher than 7.0% , the target value defined by ADA. Even among them, 20. 2% patients have never received any anti-diabetic drugs. Low-risk and medium-risk patients accounted for 16. 0%. Totally 48.0% patients were classified in high-risk group and 36. 0% in very high risk group. About half of all patients had different target organ dysfunction. About 49. 0% patients had associated comorbidities. Conclusions Co-existence of hypertension and abnormal glucose metabolism is common in Chinese population. Among these patients, target organ dysfunction and comorbidities are prevalent, but blood pressure is only effectively controlled in less than 30% patients. Low proportion of combination therapy is one of the reasons for unsatisfied control of blood pressure. It indicates that effective management of hypertension is urgent.