难治性高血压基层筛查干预技术的社区应用效果

Screening and intervention of resistant hypertension in the community

目的探讨适宜基层应用的难治性高血压(RH)筛查技术,并观察应用效果。方法2015年10月至2016年9月,采用随机抽样方法,选择浙江省杭州市、诸暨市两个研究社区纳入管理的1 171例高血压患者,对其中符合RH诊断的97例患者应用RH三步筛查流程法进行筛查,并开展个体化干预指导,比较干预前后规范治疗和生活方式改善情况。结果97例"RH"患者中,检出假性RH 7例,有甲状腺疾病病史者2例、打鼾史48例,睡眠呼吸暂停综合征1例。对90例RH患者存在的危险因素进行个体化干预,并规范用药指导。1年后结果显示,患者规范血压测量率达83.5%(75/90);规范联合降压药物治疗率由14.4%(13/90)提高到90.0%(81/90);药物治疗依从性由46.7%(42/90)提高到95.6%(86/90),血压控制率由12.2%(11/90)提高到77.8%(70/90),平均收缩压及舒张压水平分别下降20.4 mmHg(1 mmHg=0.133 kPa)和15.5 mmHg;生活方式干预取得显著成效,56.7%(51/90)的患者经常参加运动,高盐/高热卡饮食者由37.8%(34/90)下降到11.1%(10/90),肥胖患者比例由26.7%(24/90)下降到16.7%(15/90),各项差异均有统计学意义(P<0.05)。结论应用RH基层筛查干预技术,能规范基层血压测量和诊断技术,排除假性RH;提高基层医生对RH原因的分析、评估能力,以及合理用药水平;改善患者不良的生活方式,进一步提高社区高血压治疗率和控制率。

Objective To assess the screening and intervention techniques for resistant hypertension in the community.Methods Random sampling method was used to recruit 1 171 hypertensive patients from two communities in Hangzhou and Zhuji cities of Zhejiang province form October 2015 to september 2016. Among them, 97 patients with resistant hypertension were identified with the Three-steps-flow screening method and the individualized intervention was given. The standardized treatment and lifestyle changes were compared before and after intervention.Results Among 97 patients with resistant hypertension, 7 cases of pseudo resistant hypertension were detected;there were 2 cases with thyroid disease history, 48 cases with snoring history and 1 case with sleep apnea syndrome. The life style intervention and standardized medication guidance were given to 90 patients with resistant hypertension according to the individual risk factors. After one year of intervention, the results showed that the rate of normalized blood pressure was 83.5% (75/90) and the rate of standardized medication increased from 14.4%(13/90) to 90.0%(81/90), the rate of medication compliance increased from 46.7%(42/90) to 95.6%(86/90),the blood pressure control rate increased from 12.2%(11/90) to 77.8%(70/90), and the average systolic blood pressure and diastolic blood pressure levels were decreased by 20.4 mmHg (1 mmHg=0.133 kPa) and 15.5 mmHg. The life style of patients with resistant hypertension was remarkably changed, 56.7%(51/90) of patients took exercise regularly, high salt/high calorie diet decreased from 37.8%(34/90) to 11.1%(10/90), the proportion of the obese went down to 16.7%(15/90).Conclusion With the application of resistant hypertension screening and intervention, there are remarkable improvement in blood pressure control and life style changes for patients with resistant hypertension in the community.