自测血压在社区老年高血压患者管理中的作用

摘要

目的 比较社区老年高血压患者不同血压管理方式,探索社区慢性病管理的有效模式.方法 选取北京市丰台区蒲黄渝社区卫生服务中心的302例老年高血压患者,采用随机数字法分为2组,常规管理组(对照组)152例,常规高血压药物结合门诊管理,自测血压组150例,在常规管理组基础上,患者自备电子血压计,每周至少自我测量2 d(晨起、睡前)记录血压和心率值,社区门诊调整治疗方案.干预1年后,比较组间服药依从性、血压控制水平及血压控制达标情况. 结果 经1年综合管理,自测血压组患者服药依从高于对照组[94.7％(142例)与75.7％(115例),P＜0.05].自测血压组的收缩压水平低于对照组,对照组平均收缩压由管理前(168.5±37.7) mmHg(1 mmHg=0.133 kPa)降至为管理后(155.3±25.2) mmHg;而自测血压组由管理前(168.0±38.1) mmHg降低为管理后(141.7±22.9) mmHg,差异有统计学意义(P＜0.05),自测血压组干预前后血压达标率、高于对照组,差异有统计学意义(P＜0.05). 结论 患者自我参与监测血压能更有效控制血压,同时可提高社区老年慢病患者自我管理的能力.%Objective To compare the effects of different methods of blood pressure management in elderly hypertensive patients in the community,so as to explore the effective model for the management of chronic diseases.Methods 302 elderly hypertensive patients in Puhuangyu community health service center were divided into two groups by random number method:(1) receiving conventional antihypertensive drugs (control group,n=152);(2) receiving antihypertensive drugs combined with blood pressure self-measurements at least twice-weekly and real-time adjusting antihypertensive management (blood pressure self-measurements group,n =150).Medication adherence,levels of blood pressure control and blood pressure-targeting rate were compared between groups one year after intervention.Results Medication adherence rate was higher in self-measurements group than in the control group [94.7％ (142 cases) vs.75.7％ (115 cases),P＜ 0.05].After intervention,systolic pressure was decreased from (168.5±37.7) mmHg to (155.3±25.2) mmHg(1 mmHg=0.133 kPa) in the control group and from (168.0±38.1)mmHg to (141.7 ±22.9) mmHg in self-measurements group (all P＜0.05).Diastolic pressure level was similar in the two groups.There was a significant difference in the blood pressure-targeting rate between groups (P ＜0.05).Conclusions Blood pressure self-measurements are more effective in controlling blood pressure and can improve the self-management ability in elderly patients with chronic diseases in the community.