脑卒中再发与高血压的关系及其干预状况的调查分析

Investigation on relationship between the stroke recurrence and hypertension and its intervention treatment

目的调查和分析上海市城乡结合部脑卒中再发与高血压关系以及干预现状。方法于2012年1—12月以上海市浦东新区城乡结合部的社区居民作为调查对象,共纳入符合标准的脑卒中患者722例,其中421例有脑卒中再发史(再发组),301例无再发史(对照组)。采用横断面问卷调查和面对面访视方法,收集脑卒中患者的一般情况、血压水平、降压药物应用等基本资料。结果再发组平均年龄(74.00±9.12)岁和对照组(71.00±11.23)岁比较,差异有统计学意义(P<0.01),两组的年龄分布差异有统计学意义(P<0.01)。多因素回归分析发现,高血压是脑卒中再发的独立危险因素(OR=2.782,95%CI:1.812~4.271)。70~79岁年龄段再发组的舒张压(DBP)水平显著高于对照组(P<0.01)。脑卒中再发组中高血压患病率87.7%显著高于对照组73.1%(P<0.05);再发组收缩压(SBP)控制≤140 mm Hg的比率43.5%和DBP控制在<90 mm Hg的比率74.1%均显著低于对照组的65.8%和94.4%(P<0.01)。再发组间断服用降压药物者58例(13.78%)较对照组13例(4.32%)显著增高,而未服用降压药物者147例(34.92%)显著低于对照组137例(45.51%)(P均<0.01)。结论加强血压控制、提高用药的依从性可显著降低脑卒中再发,对于城市社区特别是城乡结合部脑卒中高血压的控制具有较好的指导价值。

Objectives To investigated relationship between the stroke recurrence and hypertension and blood pressure control in the population of the suburb of Shanghai. Methods A total of 722 stroke patients eligible for criteria were recruited in the suburb of Pudong New Distric from January 2012 to December 2012, which included 421 recurrent patients(recurrence group) and 301 non-recurrent patients(first-episode group). Moreover, baseline characteristics, blood pressure and anti-hypertensive drugs were evaluated by the cross-sectional survey and face-to-face interview. Results Recurrence group of average age(74.00±9.12) compared with the first-episode group, the difference was statistically significant(P<0.01), the age distribution of the two groups was statistically significant difference(P<0.01). Multivariate logistic regression analysis showed that hypertension was an independent risk factor for stroke recurrence(OR=2.782, 95% CI:1.812-4.271). Between 70-79 years old,the diastolic blood pressure level of the recurrence group was significantly higher than that of the first-episode group(P<0.01). The ratio of patients with hypertension in the recurrent group was more than that in the first-episode group(87.7% vs. 73.1%, P<0.05), while those with systolic blood pressure ≤140 mm Hg and diastolic blood pressure<90 mm Hg in the recurrent group were less than that in the first-episode group(43.5% and 74.1% vs. 65.8% and 94.4%, P<0.01). Patients who took drugs intermittently 58cases(13.78%) in the recurrence group were significantly more than those 13 cases(4.32%) in the first-episode group(P<0.01), whereas patients who did not take anti-hypertensive medicines 147 cases(34.92%) were less than 137 cases(45.51%) in the first-episode group(P<0.01). Conclusions Taking anti-hypertensive medicine regularly and raising treatment compliance played a crucial role in the blood pressure control and the prevention from the stroke recurrence.