社区高血压前期和高血压患者生活方式干预研究

The study of lifestyle intervention among patients with hypertension or pre-hypertension in communities

目的研究生活方式干预措施对社区高血压前期和高血压患者的影响,为高血压社区防治工作提供依据。方法选取浙江省嘉兴市和绍兴市社区的高血压前期及高血压患者448例为研究对象,将其分为对照组与干预组。对照组患者不给予个体化干预措施,维持目前生活方式。干预组患者给予为期1年的健康生活方式干预、技能培训和习惯培养,干预内容包括膳食管理、运动管理和戒烟限酒、心理平衡健康教育。结果经过12个月的个体化膳食管理和运动管理干预,随访研究结果显示,干预组患者摄油重和饮酒不良生活方式较对照组显著下降(4.31%︰12.78%,P<0.01;26.79%︰35.84%,P<0.05),收缩压较对照组仍然升高[(122.31±9.28)mm Hg︰(118.72±14.94)mm Hg,P<0.05]。干预组患者6分钟步行距离和健康状况自评较对照组显著上升[(551.09±9.46)m︰(489.63±4.48)m,(91.24±6.88)分︰(88.56±7.82)分,P<0.01]。干预组与对照组12个月与基线相关指标的差值进行比较,提示干预组患者体质指数(BMI)和腰围较干预前轻度下降,对照组升高,两组变化情况比较有显著差异[(-0.47±2.94)kg/m2︰(3.25±4.19)kg/m2,(-0.41±7.82)cm︰(1.31±3.87)cm,P<0.01]。两组收缩压和舒张压较干预前均下降,但干预组患者血压下降程度较对照组显著[(-6.61±7.74)mm Hg︰(-3.62±7.54)mm Hg,(-4.74±9.93)mm Hg︰(-3.99±9.60)mm Hg,P<0.01]。干预组患者血压知晓率、知晓正常高值血压范围、知晓高血压前期相关疾病、知晓有效治疗高血压前期的有效方法的人数构成比均较对照组高(P<0.05)。结论开展社区健康教育能够有效提高高血压前期和高血压患者防治知识水平,个体化生活方式干预能够有效控制体重,降低收缩压和舒张压水平,同时改善患者生活质量。

Objective To investigate the effect of lifestyle intervention on patients with hypertension or prehypertension, provide evidence of hyperension prevention and treatment. Method 448 patients with hypertension or pre-hypertension in Jiaxing and Shaoxing communities in Zhejiang province. Control group keep the usual lifestyle without individual intervention; intervention group was given 1 year healthy lifestyle education, skill and habit training, intervention included diet management, exersice management, smoking and drinking cessation, psychological balance education. Result Through 12 months＇ individual management including of diet and exersice management, the resluts showed that, compared with control group, taking more oil and drinking in intervention group dramaticly declined（4.31% vs 12.78%, P〈0.01; 26.79% vs 35.84%, P〈0.05）, systolic pressure rised [（122.31±9.28） mm Hg vs（118.72±14.94） mm Hg, P〈0.05], 6 minutes walking distance and slfreported health markly rised [（551.09±9.46） m vs（489.63±4.48） m,（91.24±6.88） vs（88.56±7.82）, P〈0.01]. The difference value of intervention and control group indicated BMI and waistline slight declined [（-0.47±2.94） kg/m^2 vs（3.25±4.19） kg/m^2,（-0.41±7.82） cm vs（1.31±3.87） cm, P〈0.01]. SBP and DBP declined in both groups, but they declined more remarkable in intervention group [（-6.61±7.74） mm Hg vs（-3.62±7.54） mm Hg,（-4.74±9.93） mm Hg vs（-3.99±9.60） mm Hg, P〈0.01]. The rates of hypertension awarness, knowing the value range of pre-hypertension, knowing the associated diseases of pre-hypertension, knowing the effective treatment of pre-hypertension were high in intervention group（P〈0.05）. Conclusion Community-based lifestyle intervention could effectively improve the knowledge of patients with pre-hypertension or hypertension, and effectively control weight, lower SBP and DBP, and improve the living quality of patients.