【作者】 张利霞；

【导师】 王林； 王存选；

【作者基本信息】 天津医科大学 ， 内科学， 2010， 硕士

【摘要】 目的：通过对天津市河西区某社区老年高血压流行病学及其相关危险因素的调查,了解本社区老年高血压的流行特点、分布特征、影响因素、高血压患者血脂情况及其服药依从性等,为进一步制定社区人群高血压的防治的相关政策、采取针对性的控制措施提供依据。方法：选取天津市河西区某社区老年人6202人,进行高血压的流行病学调查。用统一的问卷并采用直接询问法进行,详细记录患者人口学特征、高血压的既往史及家族史等。按随机抽样的原则从中抽取部分样本进行血脂、血糖检验。分别按性别、年龄、BMI、WC、WHR、WHtR、FBG和高血压分级等分组进行分析、比较。结果：1.天津市河西区某社区老年人的SBP和DBP平均水平分别为137.27±20.71mmHg和78.42±9.12mmHg。男、女SBP和DBP平均水平都随着年龄增高而升高。超重、肥胖、腹部肥胖和IFG人群的SBP和DBP平均水平均较高,SBP和DBP平均水平随着BMI、WC、WHR、WHtR和FBG的升高都呈现逐渐上升的趋势。2.6202名调查对象中,高血压患者为2716人,高血压粗患病率和标化患病率分别为43.8%和41.8%。男性分别为40.6%和38.7%,女性分别为46.4%和44.3%,女性患病率高于男性,差异有统计学意义(P=0.000)；男女高血压患病率随年龄的升高呈上升趋势(趋势χ2male=13.537,P<0.01;趋势χ2female=26.148,P=0.000)。小学及其以下、初中、高中或中专、大专及其以上等文化程度的患病率分别为47.0%、44.7%、41.2%、40.2%,高血压患病率随文化程度的升高呈下降趋势(趋势χ2=11.788,P=0.000)。工人、科医教商、离退、家务高血压患病率分别为26.2%、25.2%、44.9%、42.3%,差异有统计学意义(P=0.000)。离婚丧偶人群、已婚人群高血压患病率分别为48.2%、42.4%,差异有统计学意义(P=0.000)。3.体重不足组、正常组、超重组、肥胖组的高血压患病率分别为22.1%、36.4%、46.2%、63.8%,差异有统计学意义(P=0.000)。高血压患病率随BMI的升高呈上升趋势(趋势χ2=237.957,P=0.000)。腹型肥胖组患病率较正常组高,差异有统计学意义(P=0.000)。4.高血压1、2、3级患病率分别为22.3%、12.6%、8.8%,差异有统计学意义(P=0.000)。构成比分别为51.0%、28.8%、20.2%,差异无统计学意义(P=0.287)。ISH患病率26.7%,非ISH为17.1%,差异有统计学意义(P=0.000)。ISH、IDH、SDH构成比分别为61.0%、2.0%、36.9%,差异有统计学意义(P=0.000)。5.年龄、文化程度、职业、家族史、BMI、WC、TG和FBG可能是影响高血压患病的独立因素。6.患者知晓率、治疗率、控制率、治疗者控制率分别为68.2%、64.1%、18.5%、28.9%,其中男性为66.7%、61.6%、20.0%、32.5%,女性为69.3%、65.8%、17.5%、26.5%,男女治疗率和治疗者的控制率,差异有统计学意义(χ2=5.507,P=0.025；χ2=7.233,P=0.007)。7.高血压患者中,超重率、肥胖率、TC异常率、TG异常率、HDL-c异常率、LDL-c异常率及总血脂异常率男女之间差异均有统计学意义(P<0.01)；除了超重和HDL-c异常率男性高于女性外,余女性均高于男性。8.在高血压分级中,TC、TG差异有统计学意义(P<0.05)。在高血压类型中,TC、TG、HDL-c、LDL-c、FBG差异均无统计学意义(P≥0.05)。9.在不同BMI分组中,TG、HDL-c、LDL-c、FBG差异有统计学意义(P<0.01),TG、LDL-c、FBG水平随着BMI的增大而升高，HDL-c随着BMI的增大而降低。腹型肥胖者TC、TG、LDL-c、FBG的水平较正常组高,HDL-c水平较正常组低,部分差异有统计学意义(P<0.01)。10.女性血脂水平及异常率均高于男性,部分差异有显著性(P<0.05)。11.高血压患者CPAT佳者占67.1%；不佳者占32.9%。患者是否规律自测血压、服药种数和服药次数可能是影响CPAT的独立因素。高血压患者使用一种降压药的占71.3%,其中用前三位的是中药、CCB、复方制剂,分别占25.6%、24.8%、21.3%,服药依从性较佳的前三类药为CCB、中药、复方制剂,分别占28.1%、22.7%、21.8%(P=0.688)；联合用药占21.5%,其中符合2005年高血压指南的占26.9%。结论：天津市河西区某社区老年居民SBP和DBP平均水平均高于全国水平。老年高血压粗患病率和标化患病率较高,女性患病率高于男性,男女患病率最高组均出现在III组。在高血压分级中,1级高血压所占比例最高；在高血压类型中,ISH所占比例最高。年龄、文化程度、职业、家族史、BMI、WC、TG和FBG可能是影响高血压患病的独立因素。高血压知晓率、治疗率、控制率和高血压治疗者控制率与美国等发达国家相比仍较低。高血压患者代谢性疾病患病率均高于国内水平。社区CPAT较差,应加强社区干预,普及并落实高血压指南,强化高血压健康教育,选择最佳治疗方案,大力推广家庭自测血压,以提高高血压患者药物治疗依从性。更多还原

【Abstract】 Objective:To analyze the situation of epidemiological characteristics, distribution characteristics, risk factors,serum lipid and drug compliance of elderly hypertensive patients through investigating epidemiology and risk factors of elderly hypertensive patients in Hexi District of Tianjin. In order to further develop our public health and disease control policy.Methods:Study objects with 6702 elderly persons in Hexi District of Tianjin. demographic characteristics, hypertension history and family history were selected by questionnaire investigation and face-to-face interview. Serum lipid and blood sugar were detected in some of sample. The data were divided into different groups according age, sex, BMI, WC, WHR, WHtR, FBG, class of hypertension to analyze and compare respectively.Results:1.The mean of SBP and DBP were 137.27±20.71 mmHg and 78.42±9.12 mmHg respectively in the target population. Both means of SBP and DBP increased progressively with age for men and women. The means of SBP and DBP were higher for the population of over weight, obesity, abdomen obesity and IFG., both means of SBP and DBP increased progressively with the growth of BMI, WC, WHR, WHtR and FBG..2. Of 6202 subjects in this study,2716 were diagnosed as the patients of hypertension. The crude prevalence and the standardized prevalence of hypertension were 43.8% and 41.8% respectively. The male prevalence of that were 40.6% and 38.7%, and the female prevalence of that were 46.4% and 44.3%, the female prevalence of that was higher than the male (P=0.000). The male prevalence of hypertension increased with age increasing, and so did the female (trend chi-square testχ2male=13.537, P<0.01; trend chi-square testχ2female=26.148,P=0.000).The prevalence of hypertension were 47.0%,44.7%,41.2% and 40.2% for people with primary school education and below, junior high school education, senior high school and junior college education, college education and above. The prevalence of hypertension decreased with education increasing (P=0.000).For workers, people of the business, teacher, scientists and doctors, the retired and the unemployed, the prevalence of hypertension is respectively 26.2%,25.2%,44.9% and 42.3%,there was significant difference between occupations (P=0.000). For the divorced and bereaved,the normal married, the prevalence of hypertension is respectively 48.2% and 42.4%,there was significant difference between different marry condition (P=0.000).3.The prevalence of hypertension of underweight, normal weight group, over weight and obesity were respectively 22.1%,36.4%,46.2% and 63.8%, obesity is the highest, underweight is the lowest (P=0.000).The prevalence of hypertension increased with BMI increasing (trend chi-square testχ2=237.957, P=0.000). The prevalence of hypertension of abdominal obesity group was higher than normal group (P=0.000).4.Among the hypertensive patients, the prevalence of hypertension of grade 1,2,3 were respectively 22.3%,12.6% and 8.8%, grade 1 hypertension patients is the highest, grade 2 the second,and grade 3 the lowest (P=0.000), the proportion of those is respectively 51.0%,28.8% and 20.2%,there were no significant difference (P=0.287). The prevalence of ISH is 26.7%, the other is 17.1%, the proportion of ISH, IDH and SDH were respectively 61.0%,2.0% and 36.9%, ISH was the highest, SDH the second, and IDH the lowest (P=0.000).5. Age, education, occupation, hypertension family history, BMI, WC, TG and FBG were the independent and significant factors influencing hypertension. 6. The hypertension awareness, treatment, control and control rate of the treated were respectively 68.2%, 64.1%,18.5%and 28.9%, the male of that were respectively 66.7%,61.6%,20.0 % and 32.5%, the female of that were respectively 69.3%,65.8%,17.5% and 26.5 %, the female of treatment rate was higher than the male (χ2=5.507, P=0.025), the male of the treated control rate was higher than the female (χ2=7.233,.P=0.007).7. Among the hypertension patients, over weight, obesity, the abnormal rate of TG, TC, HDL-c, LDL-c and the total abnormal rate of serum lipid were significant difference between the male and the female (P<0.01),the male of over weight and the abnormal rate of HDL-c were higher than the female, the female of the other were higher than the male.8.TC and TG were significant difference between different class of hypertension (P<0.05).TC, TG, HDL-c, LDL-c and FBG were no significant difference in different type of hypertension (P≥0.05).9. TG, HDL-c,LDL-c and FBG were significant difference between different class of BMI (P<0.01).The level of TG, LDL-c and FBG increased with BMI increasing, the level of HDL-c decreased with BMI increasing. The level of TC, TG, LDL-c and FBG of abdominal obesity group were higher than normal group, the level of HDL-c decreased with BMI increasing. The level of HDL-c of abdominal obesity group was lower than normal group, part of them were significant difference (P<0.01).10. The level and abnormal rate of serum lipid of the female were higher than the male, part of them were significant difference between sex (P<0.05).11. The compliance rate was 67.1% and non-compliance was 32.9%. Regularity of home blood pressure monitoring, types and frequency of medication were the independent and significant factors influencing medical compliance. The patients use one kind of antihypertensive drug was 71.3%, the first three were the traditional Chinese medicine, CCB and compound preparation. The proportion of them were respectively 25.6%,24.8% and 21.3%.Better drug compliance of the first three kinds of drugs were CCB,the traditional Chinese medicine and compound preparation. The proportion of them were respectively 28.1%,22.7% and 21.8%.The proportion of drug combination was 21.5%, the proportion of consistent with prevention and treatment of Chinese hypertension guidelines was 26.9%.Conclusion:The mean of SBP and DBP of elderly hypertensive patients in Hexi District of Tianjin were higher than National level.The crude prevalence and the standardized prevalence of hypertension were higher, the female prevalence of that was higher than the male,the highest was group of 70～79 years.The prevalence of hypertension of grade 1 was highest among different class of hypertension, the prevalence of ISH was highest among different kind of hypertension. Age, education, occupation, hypertension family history, BMI, WC, TG and FBG were the independent and significant factors influencing hypertension. The hypertension awareness, treatment, control and therapist control rate were lower than United States and other developed countries.The prevalence of metabolic diseases among hypertension patients was higher than national level. The situation of CPAT was bad, to implement of hypertension guidelines, promote health education, choose the best treatment options, and call to action on use and reimbursement for home blood pressure monitoring could improve Compliance of Patient with Anti-hypertension Therapy.更多还原