高血压患者血压控制的影响因素分析

Analysis on the Influencing Factors of Blood Pressure Control of Hypertension Patients

探讨高血压患者的用药情况及影响患者血压控制的因素。方法选取2010年1月至2014年1月重庆市万州区第五人民医院与重庆三峡中心医院诊治的临床资料完整的高血压患者1068例,记录患者的用药情况,观察并记录患者血压的控制情况,对可能影响血压控制效果的因素进行单因素分析及多因素Logistic回归分析。结果高血压患者的服药率为100%,1068例患者中有473例(44.29%)血压控制良好,常用的降压药为钙离子拮抗剂(CCB)、血管紧张素转换酶抑制剂(ACEI)、β受体拮抗剂(BB),以CCB应用最多,有555例(51.97%);其次是ACEI,338例(31.65%);再次为BB,235例(22.00%);ARB、利尿剂、α受体阻滞剂以及复方制剂应用的较少,分别为201例(18.82%)、173例(16.20%)、126例(11.80%)和71例(6.65%);单因素分析显示,高龄(χ2=18.518,P<0.05)、低心血管风险程度(χ2=10.532,P<0.05)、每年>9个月的规律服药时间(χ2=4.127,P<0.05)、公费+医保医疗(χ2=38.251,P<0.05)、联合用药(χ2=36.329,P<0.05)患者的血压控制率较高;Logistic多因素回归分析显示,年龄>65岁(OR=1.737)、公费+医保医疗(OR=3.522)、心血管风险程度低(OR=3.673)、联合用药(OR=2.301)、每年>9个月的规律服药时间(OR=1.993)是影响高血压控制的独立危险因素(P<0.05)。结论临床主要应用CCB、ACEI等降压药控制血压,但血压控制效果并不理想。高龄、公费医疗、单一用药、心血管病风险、规律服药是影响高血压患者血压控制的危险因素。

Objective To investigate the medication of hypertension patients and the factors influencing the blood pressure control. Methods Total of 1068 cases of hypertension in Chongqing Wanzhou Fifth People＇s Hospital and Sanxia Central Hospital from Jan. 2010 to Jan. 2014 were included in the study,the medication and the blood pressure control status were recorded,and the possible influencing factors of blood pressure were analyzed by univariate and multivariate Logistic regression analysis. Results The medication rate of the hypertensive patients was 100%,44. 29%（ 473 /1068） patients＇ blood pressure control was good,and the common antihypertensive drugs were calcium channel blockers（ CCB）,angiotensin-converting enzyme inhibitors（ ACEI）,β receptor antagonist（ BB）. CCB was the most common drug with 555 cases（ 51. 97%）in use,the second was ACEI,with 338 cases（ 31. 65%） in use,the third was BB,with 235 cases（ 22. 00%）in use,the others were ARB（ 201 cases,18. 82%）,diuretics（ 173 cases,16. 20%）,α-receptor blocker（ 126 cases,11. 80%） and compound preparation（ 71 cases,6. 65%） respectively. Univariate analysis showed： the patients with advanced age（ χ2= 18. 518,P〈0. 05）,low cardiovascular risk level（ χ2= 10. 532,P〈0. 05）,regular medication time of 9 months per year（ χ2= 4. 127,P〈0. 05）,public and medical insurance payment（ χ2= 38. 251,P〈0. 05）,combination therapy（ χ2= 36. 329,P〈0. 05） had higher blood pressure control rate. Logistic multivariate regression analysis showed that age 65 years old（ OR = 1. 737）,public and medical insurance payment（ OR = 3. 522）,low cardiovascular risk level（ OR = 3. 673）,drug combination（ OR = 2. 301）,more than 9 months regular medication per year（ OR = 1. 993） were the independent risk factors for hypertension control（ P〈0. 05）. Conclusion The main blood pressure control drugs in clinical are CCB and ACEI,but the effect is not ideal. Elderly age,free medical care,single medication,cardiovascular disease risk,and regular medication are the risk factors that affect blood pressure control in patients with hypertension.