远程家庭血压监测对社区高血压患者血压管理的有效性及安全性研究

Efficacy and safety of remote home monitoring for blood pressure management among community patients with hypertension

目的高血压是全球人类死亡的首要危险因素,我国每年约有254万人因此而亡,其中多达95.7%的患者死于心脑血管疾病。远程家庭血压监测(home blood pressure monitoring,HBPM)已被证实可以改善血压控制情况,但临床实用性有待商榷。方法本研究在同济大学附属石泉街道社区卫生服务中心2020年9月—2022年2月入选270例口服降压药物且诊室血压控制不良的原发高血压患者,随机1∶1分配到干预组(远程家庭血压监测管理)和对照组(自我监测结合社区常规高血压管理),开展为期12个月的随机对照研究。结果270例入组患者平均年龄(59.48±11.19)岁,其中男性125人,65岁以上100人,两组间基线信息差异无统计学意义(P>0.05)。共244例患者完成12个月随访,随访结果显示干预组血压达标率为61.06%,高于对照组的41.05%;干预组患者诊室和家庭收缩压下降中位数分别为15.67 mmHg和14.24 mmHg(1 mmHg=0.133 kPa),高于对照组的12.10 mmHg(P<0.001)和11.47 mmHg(P<0.001);干预组家庭血压监测中位数频率为1.90次/周,高于对照组的0.52次/周(P<0.001)。干预组的平均服药种类、用药频度和服药依从性均显著高于对照组(均P<0.05)。结论远程家庭血压监测管理模式有助于社区血压控制不良患者诊室血压下降得更快,并能提高诊室血压控制率等指标,可在社区高血压管理中推广。

Objective To evaluate the efficacy and safety of remote home blood pressure monitoring(HBPM)for blood pressure control in community-dwelling hypertensive patients.Method From September 2020 to February 2022,270 patients with hypertension who received oral antihypertensive drugs and had poor blood pressure control in the clinic were enrolled in this study.They were randomly assigned to the intervention group(remote home blood pressure monitoring management)and the control group(self-monitoring combined with community routine hypertension management)for a 12-month with 135 cases in each group.Results The mean age of the 270 enrolled patients was(59.48±11.19)years old,including 125 males and 100 over 65 years old.There was no significant difference in baseline information between the intervention and control groups(P>0.05).A total of 244 patients were followed up for 12 months.The follow-up results showed that the blood pressure control rate of the intervention group was 61.06%,which was higher than that of the control group(41.05%).The median decrease of clinic and home systolic blood pressure in the intervention group was 15.67 mmHg and 14.24 mmHg,which were higher than those in the control group(12.10 mmHg and 11.47 mmHg,P<0.001)(1 mmHg=0.133 kPa).The median of HBPM frequency in the intervention group was 1.90 times/week,which was higher than that in the control group 0.52 times/week(P<0.05).The type of medication,medication frequency and medication compliance in the intervention group were significantly higher than those in the control group(P<0.05).Conclusion The mode of remote home blood pressure monitoring management can help patients with poor blood pressure control in the community to decrease blood pressure faster,and improve the blood pressure control rate and other indicators.It is suggested this mode may be promoted for hypertension management in the community.