不同社区管理模式对高血压患者并发心脑血管疾病的影响

Impact of community-based different hypertension management models on the incidence of cardio-cerebrovascular disease in hypertensive patients

目的评价不同社区管理模式对高血压患者并发心脑血管疾病的影响。方法 2008年8月—2012年12月在浦东新区部分社区开展高血压不同管理模式的对照研究,招募符合纳入标准的1 578名高血压患者作为研究对象并随机分为管理组和对照组。对照组采用常规高血压管理方法,管理组采用细节管理,由健康专员及社区医师负责随访以及相关资料收集。结果管理组的心脑血管发病率(1.33%)小于对照组(4.22%),差异有统计学意义(P<0.05)。多因素logistic回归分析显示,男性、年龄升高、高血压病程增长、有高血压家族史、血肌酐升高、低密度脂蛋白胆固醇升高均为心脑血管事件的危险因素(P均<0.05),而管理组发生心脑血管事件的风险是对照组的0.348倍(P<0.05)。结论高血压细节管理相对于常规管理有优势,能有效减少心脑血管事件。

Objective To evaluate different hypertension management models in communities and their impact on incidence of cardio-cerebrovascular disease in hypertensive patients. Methods A total of 1 578 hypertension patients in several communities in Pudong New Area were recruited in the study （ August 2008 to December 2012 ） according to the inclusion criteria and randomly divided into two groups.The control group was given routine hypertension management and the study group was given detailed hypertension management, while health commissioners and community physicians were in charge of the follow-up and data collection. Results The incidence of cardio-cerebrovascular disease （1.33%） in study group （1.33%） was significantly lower than that of the control group （4.22%） （ P 〈0.05）. Multivariate logistic regression analysis showed that age, male, course-of-disease, patients with hypertension family history, increase in SCr and LDL-C increased the risk for getting ardio-cerebrovascular disease （P 〈0.05）.The risk of study group was 0.348 times the control group （ P 〈0.05）. Conclusion Compared with control group, detailed hypertension management model conducted in study group has the advantages that effectively reduced the rate of cardio-cerebrovascular disease.