西北地区农村高血压患者血压及血压控制效果相关因素研究

Related factors of blood pressure and its control in hypertensive patients from rural areas of Northwest China

摘要:

目的 了解我国西北地区农村高血压群体的血压控制情况及可能影响血压控制的因素。方法 选取甘肃省武威市羊下坝镇3个自然村2016年7月前被纳入高血压管理系统的常住高血压人口作为调查对象,进行问卷调查(人口学特征、生活方式、既往病史、家族史和用药情况等)、体格检查(身高、体质量及血压)和实验室相关指标检测。采用SPSS 23.0统计软件对数据进行分析,根据数据类型,组间比较采用ANOVA检验、t检验或χ²检验；多因素分析采用多重线性回归和多因素 logistic回归分析。结果 研究共纳入512例高血压患者,年龄(64.7±9.7)岁。其中72.3%(370/512)服用降压药,该部分人群血压控制率59.2%(219/370)。单因素分析显示,来自下二沟村、不参加农务劳动和服用降压药者有较高收缩压(SBP)；年龄≥65岁、超重/肥胖、来自下二沟村、服用降压药、未曾患过心血管疾病、有高血压家族史患者有较高舒张压(DBP)。多重线性回归模型显示,SBP与服用降压药(β=0.173)、低密度脂蛋白胆固醇(LDL-C)水平呈正相关(β=0.107),与参加农务劳动呈负相关(β=-0.119)；DBP与年龄(β=0.247)和服用降压药呈正相关(β=0.156),与曾患过心血管疾病(β=-0.115)、参加农务劳动(β=-0.103)和高密度脂蛋白胆固醇(HDL-C)水平呈负相关(β=-0.104)。血压控制率单因素分析显示,不同地区(P=0.001)、是否参加农务劳动(P=0.033)、是否服用降压药(P<0.001)比较差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,参加农务劳动(OR=0.632,95%CI 0.429~0.933;P=0.021)、来自三沟村(OR=0.416,95%CI 0.262~0.660;P<0.001)和五沟村(OR=0.587,95%CI 0.378~0.911;P=0.018)为血压控制率的保护因素。结论 高血压患者的血压控制除应规范使用降压药外,还应强调健康生活方式,农村地区患者适当参加农务劳动可以更好地控制血压。

Abstract:

Objective To investigate the status and the possible influencing factors of blood pressure control in hypertensive population from the rural areas of Northwest China. Methods Hypertensive patients (permanent residents of 3 natural villages of Yangxiaba Town, Wuwei City, Gansu Province) enrolled in a hypertension management system before July 2017 were recruited and surveyed through questionnaires. Their demographic characteristics, life style, medical history, family history and drug use were investigated, and physical examination (height, body mass and blood pressure) and laboratory examination were carried out. SPSS statistics 23.0 was used to analyze the data. One-way analysis of variance (ANOVA), Student’s t test or Chi-square test was employed for the comparison between groups. Multivariate analysis were carried out with multiple linear regression and multivariate logistic regression analysis. Results The recruited 512 hypertensive patients were at an age of (64.7±9.7)years. Among them, 72.3%(370/512) participants took antihypertensive drugs, with a rate of blood pressure control of 59.2%(219/370). Single factor analysis showed that the participants from Xiaergou Village, and taking antihypertensive drugs and doing no farm work, had higher systolicblood pressure (SBP), while those with age ≥65 years, overweight/obesity, from Xiaergou Village, receiving antihypertensive drugs, no history of cardiovascular disease, and having family history of hypertension, had higher diastolic blood pressure (DBP). Multiple linear regression analysis indicated that SBP was positively correlated with receiving antihypertensive drugs (β=0.173) and LDL-C level (β=0.107), and negatively with farm work (β=-0.119). While, DBP was positively correlated with age (β=0.247) and receiving antihypertensive drugs (β=0.156), but negatively with history of cardiovascular disease (β=-0.115), farm work (β=-0.103) and HDL-C level (β=-0.104). The results of single factor analysis for blood pressure control showed that significant differences were found among different areas (P=0.001), taking part in farm work or not (P=0.033) and receiving antihypertensive drugs or not (P<0.05). Multivariate logistic regression analysis indicated that farm work (OR=0.632,5%CI 0.429-0.933; P=0.021), from Sangou Village (OR=0.416,5%CI 0.262-0.660; P<0.001) and Wugou Village (OR=0.587, 95%CI 0.378-0.911; P=0.018) were protective factors for blood pressure control. Conclusion Apart from standardized antihypertensive medication, healthy life styles should also be encouraged for hypertensive patients. Those from rural areas should take part in farm work to well control blood pressure.