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中国全科医学

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2012—2022年基本公共卫生服务项目高血压患者血压控制率趋势及影响因素分析

李丹颖1，郭晓璟1，朱晓磊2，司向2，张晓畅2，万霞1*   

  1. 1.100005北京市，中国医学科学院基础医学研究所 北京协和医学院基础学院 呼吸和共病全国重点实验室 2.100050北京市，中国疾病预防控制中心慢病和老龄健康管理处
  • 收稿日期:2025-01-08 修回日期:2025-03-23 接受日期:2025-04-02
  • 通讯作者: 万霞
  • 基金资助:
    全国重点实验室专项经费(2060204); 医科院创新工程(2023-12M-2-001)

The trend of blood pressure control rate in patients with hypertension in basic public health services from 2012 to 2022

  • Received:2025-01-08 Revised:2025-03-23 Accepted:2025-04-02
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摘要： 目的　本研究旨在分析2012-2022年国家基本公共卫生服务高血压健康管理项目患者血压控制率的变化趋势，并探讨影响因素。方法　基于中国疾病预防控制中心在8省16个县区收集的数据，采用轨迹模型（Trajectory Model）和广义线性混合效应模型（Generalized Linear Mixed-Effects Models, GLMMs）对血压控制率及其相关因素进行分析。结果　2012-2022年调查地区高血压患者血压控制标化率分别为61.3%、72.8%、71.9%、65.1%，形成三个轨迹组：低水平下降组（占18.8%），均为农村，控制率下降；低水平上升组（占29.2%），农村居多，控制率上升；高水平维持组（占52.1%），城市为主，控制率保持在75.0%以上。个体行为保护因素在各组间差异显著，保护性指标在高水平维持组中最优。社区医生服务水平在各组中均高且差异不大。在低水平下降组中，血压控制率与食物多样化评分（Dietary Diversity Score, DDS）相关；在低水平上升组中，血压控制率高和男性及身体活动充足相关；在高水平维持组中，血压控制率高与服药依从和血压知识知晓相关。结论　在调查地区中，十年间血压控制率有一定效果。多数城市点的患者控制率基本上维持在较高水平，但是，仍需要重点关注患者服药依从性及对高血压认知的健康教育；对于控制率呈上升趋势的地区，重点需要关注男性患者及身体活动的开展；对于控制率较低甚至于呈下降的地区，首先需要开展对患者健康饮食的教育。

关键词: 国家基本公共卫生服务项目, 高血压, 血压控制率, 轨迹模型, 广义线性混合效应模型

Abstract: Objective　The aim of this study is to analyze the trends in blood pressure control rates among patients with hypertension managed under the National Basic Public Health Service Program from 2012 to 2022 and to explore the influencing factors. Methods　Based on data collected by the Chinese Center for Disease Control and Prevention from 16 counties in 8 provinces (autonomous regions), a Trajectory Model and Generalized Linear Mixed-Effects Models (GLMMs) were employed to analyze blood pressure control rates and their associated factors. Results　The blood pressure control rates in the surveyed regions from 2012 to 2022 were 61.3%、72.8%、71.9% and 65.1%, respectively. And was categorized into three trajectory groups: the low-level decline group (18.8%), all of which were rural areas with a decline in control rates; the low-level increase group (29.2%), predominantly rural areas with an increase in control rates; and the high-level maintenance group (52.1%), primarily urban areas with control rates maintained above 75.0%. Individual behavioral protective factors showed significant differences among the groups, with the best protective indicators found in the high-level maintenance group. The level of community physician service was high across all groups with little variation. In the low-level decline group, blood pressure control rates were correlated with the Dietary Diversity Score (DDS) provided by community physicians. In the low-level increase group, higher blood pressure control rates were associated with male gender and sufficient physical activity. In the high-level maintenance group, higher blood pressure control rates were related to medication adherence and knowledge of blood pressure. Conclusion　During the ten years survey in the region, the blood pressure control rate has improved. In most urban areas, patients' control rates have been high, yet medication adherence and hypertension - related health education still need emphasis. In areas where control rates are rising, focus should be on male patients and promoting physical activity. For regions with low or declining control rates, initiating healthy - diet education for patients is essential.

Key words: National Basic Public Health Service Program, Hypertension, Blood Pressure Control Rate, Trajectory Model, Generalized Linear Mixed-Effects Models

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