35岁及以上社区高血压管理人群中血压变化轨迹及分布特征分析

Analysis of Blood Pressure Trajectories and Distribution Characteristics in Community-based Hypertension Management Population Aged 35 Years and Above

背景随着高血压患病人群越趋于年轻化,国家基本公共卫生服务项目将35岁及以上人群作为重点监测人群,目前社区高血压患病人数逐年增加,极大加重了社区工作的负担,但近年来较少开展纵向研究探讨社区管理高血压患者的血压变化及分布情况。目的探讨35岁及以上社区管理高血压人群血压变化趋势,揭示高血压变化轨迹及分布特征。方法本研究依托于国家基本公共卫生服务项目建立2020—2022年的回顾性队列研究,于2020年1月—2022年12月在贵阳市某区承担基本公共卫生服务的社区卫生服务中心/站选取符合《国家基本公共卫生服务规范(第三版)》中诊断标准的高血压患者为研究对象,分别通过个人基本信息表(性别、年龄及高血压病程)收集基线资料,并采用随访记录表[身高、体质量、血压、腰围(WC)、随访方式、药物依从方式及控制满意度]收集随访资料,计算研究对象的BMI、腰高比(WHtR)情况,随访频率为每半年1次,共计随访5次。采用潜变量增长曲线模型(LGCM)与增长混合模型(GMM)探索35岁及以上高血压人群中随访血压值的变化轨迹,并识别轨迹相似的潜在集群,进一步分析不同血压轨迹分组的分布特征。结果研究共纳入15958例高血压患者,高血压人群中血压初始水平及变化速率均与BMI初始水平、变化速率有关。收缩压和舒张压共呈现出3种相似的轨迹变化,收缩压和舒张压三种轨迹定义及占比分别为血压低值上升组2.1%(332/15958)/19.1%(3052/15958)、血压高值下降组5.7%(905/15958)/6.1%(975/15958)、血压中值稳定组92.2%(14721/15958)/74.8%(11931/15958)。不同收缩压轨迹分组的高血压患者病程、药物依从方式、随访方式、控制满意度、BMI、WHtR及WC比较,差异有统计学意义(P<0.05)。不同舒张压轨迹分组的高血压患者性别、年龄、病程、药物依从方式、随访方式、控制满意度、BMI、WHtR及WC比较,差异有统计学意义(P<0.05)。结论35岁及以上社区管理高血压人群血压变化轨迹主要表现为血压中值稳定。不同特征人群的血压变化轨迹表现不同,提示在社区工作人员进行高血压人群管理时,应针对性提出管理措施。

Background As the population suffering from hypertension tends to be younger,the National Basic Public Health Service Project focuses on monitoring individuals aged 35 and above.Presently,the number of hypertensive patients in the community is increasing annually,which significantly increasing the burden of community healthcare.However,few longitudinal studies have been conducted in recent years to investigate the changes in blood pressure and distribution of hypertensive patients after community management.Objective To explore the trends in blood pressure changes among hypertensive individuals aged 35 and above in community management,unveiling the trajectory and distribution characteristics of hypertension in this population.Methods This study relied on a retrospective cohort study established from 2020 to 2022 under the National Basic Public Health Service Project.From January 2020 to December 2022,hypertensive patients meeting the diagnostic criteria in the National Basic Public Health Service Specification(The Third Edition)were selected from community health service centers/stations in a certain district in Guiyang City responsible for basic public health services.Baseline data were collected using personal basic information forms(gender,age,and duration of hypertension).Follow-up data,including height,BMI,blood pressure,waist circumference(WC),follow-up methods,medication adherence,and control satisfaction,were collected using follow-up record forms.BMI,waist-to-height ratio(WHtR)of the research subjects were calculated.Follow-up was conducted every six months for a total of five times.Latent growth curve models(LGCM)and growth mixture models(GMM)were employed to explore the trajectories of blood pressure values during follow-up among hypertensive individuals aged 35 and above,and to identify latent clusters with similar trajectories.Further analysis was conducted to examine the distribution characteristics of different blood pressure trajectory groups.Results A total of 15958 hypertensive patients were included in the study,and both the baseline level and change rate of blood pressure in the hypertensive population were associated with the baseline level and change rate of BMI.Both systolic and diastolic pressures presented three similar trajectories of change.The three trajectories of systolic and diastolic blood pressure were defined and accounted for as 2.1%(332/15958)/19.1%(3052/15958)in the group of low blood pressure increase,5.7%(905/15958)/6.1%(975/15958)in the group of high blood pressure decrease,and 92.2%(14721/15958)/74.8%(11931/15958)in the group of stable mid-range blood pressure.Differences in disease duration,medication adherence,follow-up methods,control satisfaction,BMI,WHtR,and WC were statistically significant among different systolic pressure trajectory groups(P<0.05).Similarly,differences in gender,age,disease duration,medication adherence,follow-up methods,control satisfaction,BMI,WHtR and WC were statistically significant among different diastolic pressure trajectory groups(P<0.05).Conclusion Blood pressure trajectory changes in the community-based management of hypertensive individuals aged 35 and above were primarily characterized by stable mid-range blood pressure.The trajectory of blood pressure change in people with different characteristics manifested differently,suggesting that tailored management measures should be targeted for community healthcare workers managing hypertensive populations.