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目的探讨在多重心血管危险因子的中重度高血压病人中实施社区综合干预对心脑血管事件发生的影响。方法在广州荔湾区2个卫生服务站收治中重度高血压病人,分为治疗组(n=70)和对照组(各70人,常规治疗并无特殊方案),治疗组接受钙拮抗剂和利尿剂治疗,并接受健康教育等非药物治疗以及定期随访,对照组按高血压病系统管理,定期随访鼓励坚持服药等。结果治疗组患者基础收缩压(179.4±14.1)mmHg,舒张压(101.3±8.1)mmHg,总胆固醇(6.4±1.5)mmol/L,甘油三酯(1.7±1.1)mmol/L,血尿酸(438.0±110.3)μmol/L,血糖(6.2±1.3)mmol/L。治疗3年后收缩压(138.0±9.1)mmHg,舒张压(78.8±5.5)mmHg,总胆固醇(5.3±1.2)mmol/L,甘油三酯(1.6±0.9)mmol/L,血尿酸(342.9±94.9)μmol/L,血糖(5.2±1.3)mmol/L较治疗前有显著性下降(P<0.01),也较对照组有显著性下降(P<0.01),两组血压控制率分别为71%(治疗组),16%(对照组)。治疗组有1例因心脑血管病入院及死亡(1.4%),对照组有12例因心脑血管病入院(17%),4例死亡(5.7%),治疗组明显减少心脑血管死亡及入院率(P<0.01)。结论良好血压控制及健康教育可以显著减少心脑血管疾病的发生和死亡。饮食治疗是控制高血脂等心脑血管危险因子的基础,应该全面推行高血压社区综合防治,以控制迅速增加的高血压患病率以及心脑血管并发症。
Objective To explore the impact of community-based intervention on cardiovascular and cerebrovascular events in patients with moderate-to-severe hypertension with multiple cardiovascular risk factors. Methods Patients with moderate-to-severe hypertension were enrolled in two health service stations in Liwan District, Guangzhou. Patients in the treatment group (n = 70) and control group (n = 70) received no special regimen for conventional treatment. The patients in the treatment group received calcium antagonists and diuresis Medication, and non-medical treatment such as health education and regular follow-up, the control group according to hyperthyroidism system management, regular follow-up encourage adhere to medication. Results The systolic blood pressure (SBP) was significantly higher in the treatment group than those in the control group (179.4 ± 14.1 mmHg, 101.3 ± 8.1 mmHg, 6.4 ± 1.5 mmol / L, 1.7 ± 1.1 mmol / L, 438.0% ± 110.3) μmol / L, blood glucose (6.2 ± 1.3) mmol / L. Systolic blood pressure (138.0 ± 9.1) mmHg, diastolic blood pressure (78.8 ± 5.5) mmHg, total cholesterol (5.3 ± 1.2) mmol / L, triglyceride 94.9) μmol / L, blood glucose (5.2 ± 1.3) mmol / L were significantly lower than those before treatment (P <0.01), and also significantly lower than those of the control group % (Treatment group), 16% (control group). In the treatment group, 1 patient was hospitalized and died of cardiovascular and cerebrovascular diseases (1.4%), 12 patients in the control group were hospitalized for cardio-cerebral vascular disease (17%) and 4 patients died (5.7%), and the treatment group significantly reduced cardiovascular and cerebrovascular death And admission rate (P <0.01). Conclusion Good blood pressure control and health education can significantly reduce the incidence of cardiovascular and cerebrovascular diseases and death. Dietary therapy is the basis for controlling cardiovascular risk factors such as hyperlipidemia. Integrated prevention and control of hypertensive communities should be fully implemented to control the rapidly increasing prevalence of hypertension and cardiovascular and cerebrovascular complications.