信息化管理下上海莘庄社区老年高血压的诊治现状调查

A survey of current status of hypertension management in elderly of Shanghai Xinzhuang community with the informatization management system

目的 :分析信息化管理系统建立5年后上海市莘庄社区老年高血压患者的管理情况,探索进一步管理的经验及不足。方法:2012年6月至12月,上海市莘庄社区卫生服务中心组织60岁及以上老年人体格检查,采用电子血压计(Microlife3AJ1-2)连续测量3次血压,并现场询问降压药物使用和高血压的知晓情况。取3次血压平均值进行分析。血压≥140/90 mm Hg(1 mm Hg=0.133 k Pa)为高血压及血压控制不达标的定义界值。分别采用Students’t检验和χ2检验比较不同性别间连续性变量及率的差别,采用χ2趋势检验分析各个年龄组之间率的趋势。结果:1实际参加调查居民9 605名(参加率64.9%),8 347名(男性45.7%)纳入分析。2高血压患病率为56.9%,知晓率82.0%,治疗率79.1%,控制率47.8%,治疗后控制率为60.4%。3在治疗的3 760例高血压患者中,54.1%服用1种降压药物,仅10例(0.3%)服用3种以上降压药物并包括1种利尿剂,可定义为难治性高血压。4使用的降压药物中,钙通道阻滞剂最多,占45.1%,其次为血管紧张素Ⅱ受体拮抗剂(22.8%)和传统复方制剂(17.6%),肾上腺素β受体阻滞剂(4.2%)和血管紧张素转化酶抑制剂(4.1%)较少。结论:信息化管理下的莘庄社区高血压知晓率和治疗率较高,但需进一步优化管理,提高联合药物治疗比例,提高控制率。

Objectives To evaluate the current status of hypertension management in elderly with the informatization management system which has been established for 5 years in Shanghai Xinzhuang Community and to analyze the experience and shortage of the management system. Methods From June to Dec. 2012, the Health Center of Shanghai Xinzhuang community carried out the check-up for elderly aged 60 years and above. Blood pressure was measured with an electronic sphygmomanometer（Microlife 3AJ1-2） for 3 times, and the average of the 3 readings was used for analysis. The information on the use of antihypertensive drugs and the awareness of hypertension was inquired onsite. Blood pressure ≥140/90 mm Hg（1 mm Hg=0.133 kPa） is the threshold used to define hypertension and uncontrolled hypertension. Students ＇t test and chi square test were performed respectively for comparing the differences in continuous and categorical variables between male and female, and chi square test was used for examining the trends among various age groups. Results ①A total of 9 605（participation rate 64.9%） elderly residents participated in the check-up, and 8 347（male： 45.7%） were included in the present analysis. ②The prevalence of hypertension was 56.9%, and the rates of awareness, treatment, control, and control rate under treatment were 82.0%, 79.1%, 47.8%, and 60.4%, respectively. ③Among the 3 760 treated hypertensive patients, 54.1% were taking only one antihypertensive drug, and only 10 patients（0.3%） were taking 3 or more drugs including diuretics and were defined as refractory hypertension. ④ As for the hypertensive drugs, calcium channel blocker（45.1%） was the most frequently used, the second and third were the angiotensin receptor blocker（22.8%） and traditional combination compound（17.6%）, β-blockers（4.2%） and angiotensin converting enzyme inhibitors（4.1%） were the relatively less frequently used drugs. Conclusions The rates of awareness and treatment were relatively high in the Xinzhuang Community, which applying the informatization management system, however, the system needs to be improved for increasing the rate of using combination therapy, and to increase the control rate of hypertension.