35~64岁自报非高血压人群首次血压测量与非同日3次血压测量结果的差异及其影响因素分析

Differences between the First and Another 3-day Blood Pressure Levels and Associated Factors in a Self-reported Non-hypertensive Population Aged 35-64 Years

背景 目前已有相关研究者针对自报非高血压人群的首次血压测量结果与非同日3次血压测量结果进行对比分析,但以新型冠状病毒疫苗接种为背景开展的相关研究较少。目的 了解新型冠状病毒感染疫情常态化防控期间35~64岁的新型冠状病毒疫苗接种者的血压水平,分析经首次血压测量发现的疑似高血压患者的首次血压测量结果与非同日3次血压测量结果间的差异性,并探讨疑似高血压患者血压分级波动的影响因素,旨在为新型冠状病毒疫苗接种前血压测量工作的开展提供借鉴和指导。方法 采用随机抽样法,选取2021年9月至湖北省武汉市洪山区青菱街社区卫生服务中心接种新型冠状病毒疫苗者中35~64岁、自报无高血压病史的居民共2 814例作为高血压筛查对象,并对其血压进行测量,测量结果记为首测血压值。根据居民的首测血压值筛选出疑似高血压[收缩压≥140 mmHg和/或舒张压≥90 mmHg(1 mmHg=0.133 kPa)]人群,在疑似高血压患者未使用降压药物的情况下,非同日对其诊室血压进行3次规范化测量,基于非同日3次血压测量结果计算血压处于理想水平(收缩压<120 mmHg和舒张压<80mmHg)、正常高值水平(收缩压120~139 mmHg和/或舒张压80~89 mmHg)者,以及高血压(收缩压≥140 mmHg和/或舒张压≥90 mmHg)患者的占比。比较不同性别、年龄段、首测血压分级的疑似高血压患者的高血压确诊率,采用单因素及多因素有序多分类Logistic回归分析疑似高血压患者血压分级波动(基于非同日3次血压测量结果得出的血压分级较基于首次血压测量结果得出的血压分级的变化情况)的影响因素。结果 2 814例高血压筛查对象中,疑似高血压患者占36.67%(1 032/2 814)。经非同日3次血压测量后,1 032例疑似高血压患者中,8.82%(91/1 032)血压处于理想水平,14.34%(148/1 032)血压处于正常高值水平,76.84%(793/1 032)为高血压患者[其中1级高血压患者占63.68%(505/793),2级高血压患者占26.48%(210/793),3级高血压患者占9.84%(78/793)];女性[80.68%(380/471)]高血压确诊率高于男性[73.62%(413/561)],差异有统计学意义(χ^(2)=7.173,P=0.007);高血压确诊率随着疑似高血压患者首测血压分级的提高而呈上升趋势(χ^(2)趋势=23.443,P<0.001)。单因素及多因素有序多分类Logistic回归分析结果显示,性别、年龄、首次测量血压时的时间段、首次测量血压时有无心理因素、首次测量血压时环境噪声是否≥40 dB是疑似高血压患者血压分级波动的影响因素(P<0.05)。结论 经首次血压测量发现的疑似高血压患者的首次血压测量结果与非同日3次血压测量结果间存在较大差异。社区医务人员在为居民提供新型冠状病毒疫苗接种前的血压测量服务时,应保证周围环境安静,确认其心理状态良好。同时,需重点关注男性、55~64岁群体、于11:01~14:00至社区卫生服务中心接受血压测量(新型冠状病毒疫苗接种)服务者的血压能否真实反映其血压水平,以保证血压测量结果的可靠性,确保疫苗接种工作的顺利进行。

Background Previous studies have compared the first and another 3-day blood pressure levels in populations with no history of self-reported hypertension,but there have been few studies conducted in COVID-19 vaccine recipients.Objective To understand the blood pressure levels among 35-64-year-old COVID-19 vaccine recipients during regular COVID-19 containment,and to assess the differences between the first and another 3-day blood pressure levels and the factors affecting the fluctuation of blood pressure levels in the recipients with suspected hypertension,providing a reference and guidance for blood pressure measurement before COVID-19 vaccination.Methods In September 2021,2814 residents aged 35-64 with no history of self-reported hypertension were randomly selected for screening for hypertension before receiving COVID-19 vaccination at Qingling Community Health Service Center,Hongshan District,Wuhan City,Hubei Province.Blood pressure was measured and recorded as the first blood pressure measurement value,then based on this,those who were found with suspected hypertension〔systolic blood pressure≥140 mmHg and/or diastolic blood pressure≥90 mmHg(1 mmHg=0.133 kPa)〕standardizedly measured their clinic blood pressure for another three times on different days without the use of any antihypertensive drugs.Based on the 3-day blood pressure measurement results,the proportions of those with blood pressure in the ideal range(systolic blood pressure<120 mmHg and diastolic blood pressure<80 mmHg),in the high normal range(systolic blood pressure:120-139 mmHg and/or diastolic blood pressure:80-89 mmHg),and in the hypertensive range(systolic blood pressure≥140 mmHg and/or diastolic blood pressure≥90 mmHg)were calculated,and the rate of hypertension diagnosis was compared between them by sex,age group,and the first blood pressure measurement level.The factors affecting the fluctuation of blood pressure levels(changes in blood pressure analyzed based on comparing the first blood pressure level and the 3-day blood pressure levels)in suspected hypertensive patients were analyzed using univariate and multivariate ordered Logistic regression.Results Of the 2814 cases,36.67%(1032/2814)were suspected hypertensive patients.Analysis of the 3-day blood pressure levels indicated that the proportions of suspected hypertensive patients with a blood pressure level in the ideal range,high normal range and hypertensive range were 8.82%(91/1032),14.34%(148/1032),and 76.84%(793/1032),respectively.Among the cases with confirmed hypertension,the prevalence of stages 1,2,and 3 hypertension was 63.68%(505/793),26.48%(210/793)and 9.84%(78/793),respectively.The hypertension diagnosis rate was higher in females〔80.68%(380/471)〕than that in males〔73.62%(413/561)〕,with statistical significance(χ^(2)=7.173,P=0.007).The hypertension diagnosis rate increased with the increase in the first blood pressure level in suspected hypertensive patients(χ^(2) trend=23.443,P<0.001).The factors affecting the fluctuation of blood pressure levels in suspected hypertensive patients were gender,age,time period for first blood pressure measurement,psychological factors and environmental noise≥40 dB during first blood pressure measurement(P<0.05).Conclusion There are significant differences between the first blood pressure measurement results and 3-day blood pressure measurement results among suspected hypertensive patients.To improve the reliability of blood pressure measurement results to ensure the successful implementation of COVID-19 vaccination,it is suggested for community medical workers to ensure the vaccine recipients are in good mental state,and pre-vaccination blood pressure measurement for them is performed in a quiet environment,and to pay more attention to verify the reliability of pre-vaccination blood pressure level in males,the 55-64 age group,or individuals receiving blood pressure measurement at community health centers between 11:01 in the morning and 14:00 in the afternoon.