远程动态血压监测下综合干预在社区高血压管理中的应用效果及影响因素研究

Objective: To explore the effect and associated factors of comprehensive community interventions for hypertension control based on remote ambulatory blood pressure monitoring(RABPM).Methods 1 000 patients with hypertension were selected from 41 community health centers in Guangzhou between January 2015 and September 2016 by multi-stage random sampling.All of them signed a contract with the community general practitioner and enjoyed the one-to-one contractual services,and received the comprehensive community interventions for hypertension control delivered by health mangers,family doctors,and the patient's family members based on the blood pressure levels measured by a new type of RABMP.The intervention effects were evaluated by the status of hypertension control,health behaviors and BMI of patients at the end of 6-month,12-month and 18-month intervention.Multivariate Logistic regression analysis was carried out to determine the factors associated with hypertension control outcome.Results: A total of 954 cases who completed the trial were included for further analysis.The 18-month follow-up showed the following results:At the end of 6-month intervention,although the mean diastolic blood pressure(DBP) of the patients changed a little(P>0.05),the mean systolic blood pressure(SBP) decreased significantly(P<0.05) compared with baseline.Compared with at the end of 6-month intervention,both mean DBP and SBP levels of them were much lowered when they finished 12-month intervention(P<0.05).When the 18-month intervention ended,the patients were found with both lower mean DBP and SBP levels compared with at the end of 12-month intervention(P<0.05),and were identified with lower rate of lack of exercise,lower mean BMI and longer mean duration of exercise(P<0.05) but similar prevalence of smoking and alcohol consumption(P>0.05) compared with baseline.The rate of hypertension control increased as the intervention went on(P<0.05).Multivariate Logistic regression analysis revealed that age,concomitant illness,smoking and BMI were associated factors for hypertension control outcome(P<0.05).Conclusion: Comprehensive interventions based on RABPM could effectively improve the hypertension control outcome of community-dwelling hypertensive patients.Age,concomitant illness,smoking and BMI of the patients could influence the management effect.