苏北农村地区高血压患者降压药物的使用及血压控制情况分析

Use and effect analysis of antihypertensive drugs in patients with hypertension in rural areas of Northern Jiangsu Province

目的调查江苏省苏北农村高血压患者药物使用和血压控制效果等情况,筛选出性价比高的用药方案,为指导农村地区合理选用降压药物提供依据。方法对苏北农村四个高血压规范化管理基地的高血压患者资料进行统计分析,筛选出较为常用的降压药物用药方案;以采用五大类降压药物和中成药/复方制剂治疗且随访过程中未自行换药/停药的高血压高危患者为研究对象,对高血压高危患者常见用药方案和血压控制率进行比较。结果高血压队列中,符合条件的高血压高危患者3 009例,其常见的用药方案有九种,分别为复方制剂、单用血管紧张素转移酶抑制剂(ACEI)、单用钙拮抗剂(CCB)、CCB+ACEI、单用利尿药、CCB+复方制剂、复方制剂+中成药、ACEI+复方制剂、利尿药+CCB;九种用药方案治疗高危患者规范化管理1年后血压控制率差异有统计学意义(χ~2=30.11,P<0.01);Scheffé置信区间法进行率的多重比较结果表明单用CCB类降压药与单用ACEI类降压药血压控制率差异有统计学意义(0.015 4,0.256 0)。结论九种常见用药方案中,利尿剂+CCB血压控制率最高,单用CCB的血压控制率高于单用ACEI类;推荐苏北农村地区高血压高危患者首选CCB类药物或采用CCB类药物为核心的组方。

Objective To investigate the using of antihypertensive drug and the blood pressure control effect of hypertension patients in rural areas of Northern areas in Jiangsu Province,to screen out cost-effective treatment regimen,and to provide evidences for guiding the rational selection of antihypertensive drugs in rural areas.Methods The data of hypertension patients in four standardized management points in rural areas of Northern Jiangsu were statistically analyzed,and the commonly used antihypertensive treatment regimens were selected.Patients at high risk of hypertension who were treated with five categories of antihypertensive drugs and/or Chinese traditional medicine/compound preparation,and did not change or stop their medication plan by themselves during the follow-up were selected as study subjects.Medication regimens and blood pressure control rates of patients at high risk of hypertension were compared.Results There were 3009 eligible patients with high risk of hypertension in the hypertension cohort study,and there were nine common drug treatment regimen,including compound preparation,ACEI,CCB,CCB+ACEI,Diuretic,CCB+compound preparation,compound preparation+Traditional Chinese medicine,ACEI+compound preparation,and Diuretic+CCB.There were significant differences in the blood pressure control rate after one year of standardized management in high-risk patients treated with nine drug regiments(χ2=30.11,P<0.01).The result of Schefféconfidence interval showed that the blood pressure control rate in the using of CCB was significantly higher than that of ACEI(0.0154,0.2560).Conclusions Among the nine common drug regimens,the blood pressure control rate of Diuretics+CCB was the highest,and the rate in the using of CCB was higher than that of ACEI.CCB drugs were recommended as the first choice,or adopt the compound with CCB drugs as the core prescription for patients with high risk of hypertension in rural areas in Northern Jiangsu Province.