上海市金山区朱泾社区高血压患者患病、血压值及2型糖尿病并发影响因素分析

Analysis on influencing factors of prevalence,blood pressure and type 2 diabetes among hypertension patients in Zhujing Community of Jinshan District in Shanghai

目的了解上海市金山区朱泾社区高血压患者患病状况及并发2型糖尿病情况,以针对不同特征人群制定个体化的干预措施,并为科学防控提供依据。方法使用上海市金山区朱泾社区卫生服务中心慢性病管理系统内,截至2020年9月30日仍在管理的13589例原发性高血压患者资料进行分析,分析高血压患者血压值及并发2型糖尿病的影响因素。结果上海市金山区朱泾社区13589例高血压患者中,男性6626例(48.76%),平均年龄为(68.29±10.94)岁;女性6963例(51.24%),平均年龄为(70.88±10.80)岁,男性发病年龄早于女性(t=13.89,P<0.05)。并发2型糖尿病3148例,占全部病例的23.17%;其中男性1444例(45.87%),平均年龄为(69.47±10.13)岁;女性1704例(54.13%),平均年龄为(71.48±9.35)岁;男性发病年龄早于女性(t=5.75,P<0.05)。13589例原发性高血压患者中,男性涉盐重、心理调适差、遵医行为差、吸烟和饮酒的比例高于女性,差异均有统计学意义(均P<0.05);随着年龄的增长,原发性高血压患者心理调适差、目前有症状、有并发症及不锻炼的比例逐渐升高,差异均有统计学意义(均P<0.05);农村地区患者心理调适差、遵医行为差、目前有症状、不服药、不锻炼、吸烟和饮酒的比例均高于城镇地区,差异均有统计学意义(均P<0.05)。农村地区、<65岁、男性、涉盐重、心理调适差、遵医行为差、没有并发症、没有目前症状、吸烟、饮酒的患者收缩压和舒张压均高,差异均有统计学意义(均P<0.05)。血压高(OR=1.30,95%CI:1.15~1.47)、体质指数(body mass index,BMI)≥24 kg/m^(2)(OR=1.23,95%CI:1.13~1.33)、女性(与男性相比,OR=1.14,95%CI:1.05~1.23)、城镇(与农村相比,OR=1.54,95%CI:1.42~1.67)、年龄递增(OR=1.01,95%CI:1.00~1.01)、并发慢性心力衰竭(与无慢性心力衰竭相比,OR=0.24,95%CI:0.19~0.31)及目前症状视力模糊(与无视力模糊相比,OR=0.76,95%CI:0.59~0.99)是高血压并发2型糖尿病的独立危险因素。结论上海市金山区朱泾社区高血压患者血压值及2型糖尿病并发与多方面因素具有密切关联,应针对不同人群开展干预措施。在高血压患者中做好防控糖尿病工作的同时,也要重视在糖尿病人群中预防高血压,并结合家庭医生团队管理模式,做到双管齐下。

Objective To understand the prevalence of hypertension and condition of hypertension complicated with type 2 diabetes among patients in Zhujing Community of Jinshan District in Shanghai,develop individualized intervention measures for people with different characteristics,and provide a basis for scientific prevention and control.Methods The data of 13589 patients primary hypertension in management as of September 30,2020 in chronic disease management system of Zhujing Community Health Service Center in Jinshan District of Shanghai were used to analyze the blood pressure value and influencing factors for complicating with type 2 diabetes.Results Of the 13589 hypertension patients in Zhujing Community in Jinshan District of Shanghai,there were 6626 males(48.76%)with average age of(68.29±10.94)years old and 6963 females(51.24%)with average age of(70.88±10.80)years old,and male onset age was earlier than female(t=13.89,P<0.05).Of the 13589 patients with primary hypertension,3148 were complicated with type 2 diabetes,accounting for 23.17%of all cases.Of the 3148 patients with hypertension and type 2 diabetes,there were 1444 males(45.87%)with average age of(69.47±10.13)years old and 1704 females(54.13%)with average age of(70.88±10.80)years old,and male onset age was earlier than female(t=5.75,P<0.05).Among the13589 patients with primary hypertension,the proportions of those with higher salt intake,poor psychological adjustment,poor medical compliance,smoking and drinking in males were higher than those in females(all P<0.05).The proportions of primary hypertension patients with poor psychological adjustment,current symptoms,complications,and no exercise increased with age(all P<0.05).The proportions of patients with poor psychological adjustment,poor medical compliance,current symptoms,no medication,no exercise,smoking and drinking in rural area were higher than those in town area(all P<0.05).The patients who were from rural areas,<65 year old,with higher salt intake,poor psychological adjustment,poor medical compliance,no complications,no current symptoms,smoking and drinking had higher systolic and diastolic blood pressure(all P<0.05).The high blood pressure(OR=1.30,95%CI:1.15-1.47),body mass index(BMI)≥24 kg/m^(2)(OR=1.23,95%CI:1.13-1.33),female(compared with male,OR=1.14,95%CI:1.05-1.23),town(compared with rural area,OR=1.54,95%CI:1.42-1.67),age increase(OR=1.01,95%CI:1.00-1.01),complicated with chronic heart failure(compared with no chronic heart failure,OR=0.24,95%CI:0.19-0.31)and currently symptomatic blurred vision(compared with no blurred vision,OR=0.76,95%CI:0.59-0.99)were independent risk factor for hypertension complicated with type 2 diabetes.Conclusions The blood pressure and type 2 diabetes among hypertension patients in Zhujing Community of Jinshan District in Shanghai are closely related to many factors,and different forms of interventions should be carried out for different groups.While preventing and controlling diabetes among patients with hypertension,it is necessary to pay attention to the prevention of hypertension in the population with diabetes,and combine the family doctor team management mode to achieve two-pronged.