不同血压管理模式对原发性高血压患者血压管理的影响

Effect of different blood pressure management modes on blood pressure management in patients with essential hypertension

目的探讨远程监测血压管理模式、自我监测血压管理模式及门诊血压管理模式对原发性高血压患者血压水平及血压达标率的影响。方法招募原发性高血压患者441例,随机分为远程组156例、非远程组144例及常规组141例。远程组及非远程组患者配发相同型号智能电子血压计,分别按照远程监测血压管理模式和自我监测血压管理模式进行血压管理;常规组患者按照门诊血压管理模式进行血压管理,定期到社区门诊由医师测量血压。记录所有患者管理前及管理6个月后诊室血压水平、血压达标率、用药情况、体质量指数、腰围及生活方式等情况。结果与管理前比较,管理6个月后,三组患者的收缩压及舒张压均显著下降(t=5.611~14.434,P<0.05),远程组收缩压和舒张压管理前后差值均显著高于常规组与非远程组(F=-2.984~-14.803,P<0.05)。管理6个月后,远程组血压达标率显著高于常规组与非远程组(χ^(2)=12.688、14.066,P<0.05),远程组服用降压药物种数显著高于常规组及非远程组(F=38.571,t=5.859、8.325,P<0.05),远程组联合用药比例高于非远程组及常规组(χ^(2)=31.058、56.524,P<0.05);常规组与非远程组上述指标比较差异均无显著性(P>0.05)。在改善生活方式方面,管理前及管理6个月后各组之间均无显著差异(P>0.05)。结论远程监测血压管理模式相较于自我监测血压管理模式和门诊血压管理模式能更好地管理血压,提高患者的血压达标率,并提高患者联合用药的比例。

Objective To investigate the effect of blood pressure telemonitoring management mode,blood pressure self-monitoring management mode,and outpatient blood pressure management mode on the level of blood pressure and the rate of reaching the standard for blood pressure in patients with essential hypertension.Methods A total of 441 patients with essential hypertension were recruited and randomly divided into telemonitoring group with 156 patients,non-telemonitoring group with 144 patients,and conventional group with 141 patients.The patients in the telemonitoring group and the non-telemonitoring group were provided with the same model of intelligent electronic blood pressure monitor,and they were managed in accordance with the telemonitoring management mode and the self-monitoring management mode,respectively.The patients in the conventional group received blood pressure management according to the outpatient blood pressure management mode and were asked to go to the community clinic regularly to have their blood pressure measured by a physician.Related data were recorded before management and after 6 months of management,including office blood pressure,the rate of reaching the standard for blood pressure,medication,body mass index,waist circumference,and lifestyle.Results After 6 months of management,all three groups had significant reductions in systolic blood pressure and diastolic blood pressure(t=5.611-14.434,P<0.05).The telemonitoring group had significantly greater changes in systolic blood pressure and diastolic blood pressure after management compared with the conventional group and the non-telemonitoring group(F=-2.984--14.803,P<0.05).After 6 months of management,compared with the conventional group and the non-telemonitoring group,the telemonitoring group had a significantly higher rate of reaching the standard for blood pressure(χ^(2)=12.688,14.066,P<0.05),a significantly higher number of antihypertensive drugs(F=38.571,t=5.859,8.325,P<0.05),and a significantly higher proportion of patients receiving combined medication(χ^(2)=31.058,56.524,P<0.05),and there were no significant differences in the above indicators between the conventional group and the non-telemonitoring group(P>0.05).There was no significant difference in the improvement of life style between the three groups before ma-nagement and after 6 months of management(P>0.05).Conclusion Compared with blood pressure self-monitoring management mode and outpatient blood pressure management mode,blood pressure telemonitoring management mode can better manage blood pressure,improve the rate of reaching the standard for blood pressure,and increase the proportion of patients with combined medication.