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Objective:To analyze the control status of ambulatory blood (BP) pressure and influencing factors among hypertensive patients in Shanghai Fengpu community.Methods:From April 2020 to February 2022, 318 hypertensive patients in Shanghai Fengpu community were enrolled in the study. The basic information and thropometric indicators of patients, course of hypertension, the medication, complications, life habits, and biochemical indicators as well as the ambulatory BP monitoring (ABPM) data were collected. Multivariate analysis was used to evaluate the risk factors for lack of 24-hour BP control.Results:Among 318 patients, 63 cases (19.8%) had an average 24-hour BP controlled; the control rate of daytime BP and nighttime BP was 23.3% (74 cases) and 15.7% (50 cases), respectively. The proportion of combined medication in the control group and non-control group was 46.0% (29/63) and 51.8% (132/255), respectively (χ 2=0.66, P=0.415). There were significant differences in gender, proportion of patients with hypertension>10 years, the office blood pressure control rate, the abnormal diastolic circadian rhythm, abdominal obesity, the level of fasting blood glucose, diabetes, physical activity levels, and smoking and drinking (all P<0.05) between the control group and non-control group. Multivariate analyses showed that male gender ( OR=2.00, 95 %CI:1.07-3.76) and abdominal obesity ( OR=2.04, 95 %CI:1.10-3.76) were risk factors for uncontrolled ambulatory BP. Conclusions:The control rate of ambulatory BP in patients with hypertension is relatively low in Shanghai Fengpu community. The ABPM should be enhanced and the management for hypertensive patients with abdominal obesity and lack of physical activity should be strengthened in the community.
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BACKGROUND: Strict medication guidance and lifestyle interventions to manage blood pressure (BP) in hypertensive patients are typically difficult to follow. OBJECTIVE: To evaluate the 1-year effectiveness of lifestyle and drug intervention in the management of rural hypertensive patients. DESIGN: Randomized community intervention trial. PARTICIPANTS: The control group comprised 967 patients who received standard antihypertensive drug intervention therapy from two communities, whereas the intervention group comprised 1945 patients who received antihypertensive drug and lifestyle intervention therapies from four communities in rural China. MAIN MEASURES: Data on lifestyle behaviors and BP measurements at baseline and 1-year follow-up were collected. A difference-in-difference logistic regression model was used to assess the effect of the intervention. KEY RESULTS: BP control after the 1-year intervention was better than that at baseline in both groups. The within-group change in BP control of 59.3% in the intervention group was much higher than the 25.2% change in the control group (P < 0.001). Along with the duration of the follow-up period, systolic and diastolic BP decreased rapidly in the early stages and then gradually after 6 months in the intervention group (P < 0.001). In the intervention group, drug therapy adherence was increased by 39.5% (from 48.1% at 1 month to 87.6% at 1 year) (P < 0.001), more in women (45.6%) than in men (31.2%; P < 0.001). The net effect of the lifestyle intervention improved the rate of BP control by 56.1% (70.8% for men and 44.7% for women). For all physiological and biochemical factors, such as body mass index, waist circumference, lipid metabolism, and glucose control, improvements were more significant in the behavioral intervention group than those in the control group (all P < 0.001). CONCLUSION: The addition of lifestyle intervention by physicians or nurses helps control BP effectively and lowers BP better than usual care with antihypertensive drug therapy alone.
Subject(s)
Antihypertensive Agents , Hypertension , Life Style , Antihypertensive Agents/pharmacology , Antihypertensive Agents/therapeutic use , Blood Pressure , China/epidemiology , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Male , Pharmaceutical PreparationsABSTRACT
Objective@#To survey on the home blood pressure measurement and blood pressure control rate among patients with hypertension in Beijing Yuetan community.@*Methods@#A questionnaire survey was conducted among 504 hypertensive patients, who were visiting Beijing Yuetan Community Health Service Center and selected by convenience-sampling method during June 2018 to January 2019. The status of home blood pressure measurement, the awareness of hypertension, the blood pressure control rate and factors related to not regularly measuring were surveyed.@*Results@#Of the 504 patients, 93.7% (472/504) took regular medication, but only 61.5% (310/504) had regular blood pressure measurements; 92.5% (466/504) had sphygmomanometers at home with electronic type mainly; 89.9% (453/504) patients knew the method of blood pressure measurement, but only 11.5% (52/453) had their sphygmomanometer calibrated. Among those who measured blood pressure, 77.4% (240/310) measured per week. The main reason for not measuring blood pressure regularly was that there was no need to measure blood pressure without any discomfort, accounting for 50.0% (97/194). The office blood pressure control rate (with desktop mercury sphygmomanometer) was 62.3% (314/504); the blood pressure control rate both in the morning and at bed time was 61.3% (73/119), that in the morning was 68.1% (81/119) and at bed time was 75.6% (90/119). The control rates of systolic blood pressure and heart rate by home measurement at morning and bedtime were significantly higher than those by office measurement (χ2=5.02, 9.97, 15.51, 13.72; all P<0.05).@*Conclusions@#The home blood pressure monitoring rate and knowledge level of hypertension among patients with hypertension in Yuetan community are relatively low. There are some differences in blood pressure control rate between office measurement and home measurement. Comprehensive evaluation is needed in the management process, and the treatment plan should be adjusted according to the specific condition of patients.
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Objective To learn the implementation and effects of standardized management of hypertension in Xiangshan. Methods A total of 1500 patients who were over 35 years and admitted to community hypertension management were enrolled in the research. The patients were given standardized management of hypertension, and acceptance questionnaire survey and physical examination. Multivariate logistic regression model was used to analyze the influencing factors of blood pressure control. Results Totally 597 patients were managed according to the standardized management requirements, and the standardized management rate was 39.80％ . All patients were received blood pressure ≥1 times /year, 84.00％ , 84.47％ , 78.27％ and 77.67％ of the patients were received dietary guidance, physical activity guidance, guidance and control tobacco smoking cessation / drinking / alcohol limit guidance respectively. The standardized blood pressure control rate was 42.20％ , which was higher than that of the non standardized management patients (31.01％), and the difference was statistically significant (P<0.05) . Logistic regression showed that high education background (ORjunior middle scho l=0.86, 95％ CI: 0.78-0.95;ORhighscho landabove= 0.76, 95％ CI: 0.68-0.85), excessive waist circumference (OR=0.93, 95％ CI: 0.89-0.97), obesity (OR=0.66, 95％ CI: 0.47-0.93) , receiving dietary guidance, (OR=0.73, 95％ CI: 0.56-0.95 ) , receiving physical activity guidance (OR=0.89, 95％CI: 0.81-0.98), acceptance of standardized management (OR=0.74, 95％CI: 0.62-0.88) were promote factors of blood pressure control. Elder (OR=1.29, 95％CI: 1.08-1.54), male (OR=1.12, 95％ CI: 1.02-1.23), living in rural areas (OR=1.09, 95％ CI: 1.03-1.15) and high income (OR=2.01, 95％ CI: 1.31-3.08) were barriers of blood pressure control. Conclusion Providing standardized management services for patients with hypertension can effectively control the blood pressure level.
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Objective To know the prevalence rate of hypertension and the rates of illness-awareness,medication and blood pressure control in Wenzhou. Method With random cluster sampling,1 034 residents aged≥15 yrs were selected from the communities of Wenzhou,and investigated with the standard questionnaires. Results The prevalence rate of hypertension in Wenzhou was 38.97% and the standardized rate was 22.27%. Among the patients with hypertension,51.12% of them were aware,and only 40.69% of them took medication and 9.18% of them had their blood pressure controlled. Conclusion The prevalent rate of hypertension is higher,but the awareness rate,medication rate and controlling rate are lower in Wenzhou city. The comprehensive interventions are needed for the prevention and treatment of hypertension.
