家庭医生签约管理的H型高血压患病现状及风险研究

Current status and risk of contracted management of H-type hypertension by family doctors

目的 探讨H型高血压与心血管疾病的发生发展及预后不良的相关性。方法 选取2020年1月—2021年12月在宛平社区卫生服务中心就诊且与家庭医生签约管理的高血压患者769例,以血浆同型半胱氨酸(Hcy)水平分为H型高血压组(n=362, Hcy≥10μmol/L)和非H型高血压组(n=407, Hcy<10μmol/L)。采用问卷调查法收集患者基本信息。计算H型高血压检出率;分析H型高血压患者的患病情况及其危险因素。结果 共纳入患者769例,H型高血压患者362例,检出率为47.1%。男性检出率为55.5%(151/272),高于女性的42.5%(211/497),差异有统计学意义(P<0.05)。H型高血压组患者颈动脉内膜中层厚度(IMT)、腰围、糖化血红蛋白(HbAlc)、尿酸(UA)、尿素氮(BUN)、甘油三酯(TG)高于非H型高血压组,高密度脂蛋白胆固醇(HDL-C)、估算肾小球滤过率(eGFR)低于非H型高血压组,差异有统计学意义(P<0.05)。男性、吸烟、老年人、IMT增厚、eGFR下降、腰围增大、BUN升高、UA升高、HbAlc升高是H型高血压的危险因素(P<0.05)。结论 H型高血压在家庭医生签约管理的高血压患者中检出率较高,且常伴有代谢紊乱和靶器官损害。家庭医生需加强对H型高血压患者的重视和管理。

Objective To investigate the correlations of H-type hypertension with the occurrence, development and poor prognosis of cardiovascular diseases.Methods From January 2020 to December 2021, a total of 769 hypertensive patients who visited Wanping Community Health Service Center and were contracted with family doctors were selected.According to plasma homocysteine(Hcy) level, the patients were divided into H-type hypertension group(n=362, Hcy≥10 μmol/L) and non-H-type hypertension group(n=407, Hcy<10 μmol/L).The basic information of patients was collected by questionnaire.The detection rate of H-type hypertension was calculated;the prevalence situation and risk factors of H-type hypertension were analyzed.Results A total of 769 patients were enrolled, including 362 H-type hypertension patients, with a detection rate of 47.1%.The detection rate of male was 55.5%(151/272), which was significantly higher than 42.5%(211/497) of female(P<0.05).Carotid intima-media thickness(IMT), waist circumference, glycosylated hemoglobin(HbAlc), uric acid(UA), urea nitrogen(BUN) and triglyceride(TG) in the H-type hypertension group were significantly higher than those in the non-H-type hypertension group, high density lipoprotein cholesterol(HDL-C) and estimated glomerular filtration rate(eGFR) were significantly lower than those in the non-H-type hypertension group(P<0.05).Male, smoking, elderly, thickened IMT, decreased eGFR, increased waist circumference, increased BUN, increased UA, and increased HbAlc were risk factors for H-type hypertension(P< 0.05).Conclusion H-type hypertension has a high detection rate in hypertensive patients contracted by family doctors, and is often accompanied by metabolic disorders and target organ damage.Family doctors should pay more attention to patients with H-type hypertension and strengthen their management.