Chinese General Practice ›› 2022, Vol. 25 ›› Issue (10): 1197-1205.DOI: 10.12114/j.issn.1007-9572.2022.0163
Special Issue: 社区卫生服务最新研究合集
• Article • Previous Articles Next Articles
Hypertension and Glycemic Control and Associated Factors for Poor Control in Patient Populations at High Risk of Atherosclerotic Cardiovascular Disease in the Community
1.Community Health Management Center,Shenzhen Luohu People's Group,Shenzhen 518005,China
2.Department of General Practice,Shenzhen University Health Science Center,Shenzhen 518061,China
*Corresponding author:YIN Zhaoxia,Chief physician,Professor,Master supervisor;E-mail:yinzhaoxia@163.com
Received:
2020-09-30
Revised:
2021-07-22
Published:
2022-04-05
Online:
2022-03-28
通讯作者:
尹朝霞
基金资助:
CLC Number:
YIN Zhaoxia, LUO Youlia, TAN Siwen, CHEN Yanli, FENG Haixuan, GONG Weijie.
Hypertension and Glycemic Control and Associated Factors for Poor Control in Patient Populations at High Risk of Atherosclerotic Cardiovascular Disease in the Community [J]. Chinese General Practice, 2022, 25(10): 1197-1205.
项目 | 单纯高血压患者(n=130) | 高血压合并糖尿病患者(n=160) | 患有糖尿病者a(n=169) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
血压控制达标组(n=42) | 血压控制未达标组(n=88) | 检验统计量值 | P值 | 血压控制达标组(n=98) | 血压控制未达标组(n=62) | 检验统计量值 | P值 | 血糖控制达标组(n=71) | 血糖控制未达标组(n=98) | 检验统计量值 | P值 | ||
年龄f(岁) | 67.0±6.5 | 61.7±9.3 | 3.758b | <0.001 | 65.4±5.7 | 62.9±7.7 | 2.203b | 0.031 | 63.9±6.2 | 64.9±6.8 | 0.979c | 0.329 | |
男性g | 28(66.7) | 70(79.5) | 2.541d | 0.111 | 52(53.1) | 38(61.3) | 1.045d | 0.307 | 41(57.7) | 54(55.1) | 0.117d | 0.732 | |
文化程度g | 0.032e | 0.975 | 0.811e | 0.417 | 0.250e | 0.802 | |||||||
本科及以上 | 4(9.5) | 7(8.0) | 5(5.1) | 5(8.1) | 3(4.2) | 7(7.1) | |||||||
高中或大专 | 16(38.1) | 31(35.2) | 45(45.9) | 23(37.1) | 31(43.7) | 38(38.8) | |||||||
中专或初中 | 13(31.0) | 37(42.0) | 31(31.6) | 18(29.0) | 21(29.6) | 35(35.7) | |||||||
小学及以下 | 9(21.4) | 13(14.8) | 17(17.3) | 16(25.8) | 16(22.5) | 18(18.4) | |||||||
深圳市户口g | 25(59.5) | 48(54.5) | 0.286d | 0.593 | 63(64.3) | 34(54.8) | 1.420d | 0.233 | 39(54.9) | 64(65.3) | 1.862d | 0.172 | |
吸烟g | 9(21.4) | 25(28.4) | 2.707d | 0.439 | 19(19.4) | 14(22.6) | 0.843d | 0.656 | 11(15.5) | 23(23.5) | 2.906d | 0.234 | |
对饮食的关注情况g | 1.633e | 0.103 | 0.692e | 0.489 | 1.173e | 0.241 | |||||||
不关注 | 9(21.4) | 37(42.0) | 32(32.6) | 20(32.3) | 21(29.6) | 34(34.7) | |||||||
一般关注 | 19(45.2) | 25(28.4) | 33(33.7) | 27(43.5) | 26(36.6) | 40(40.8) | |||||||
非常关注 | 14(33.3) | 26(29.5) | 33(33.7) | 15(24.2) | 24(33.8) | 24(24.5) | |||||||
规律运动g | 32(76.2) | 59(67.0) | 1.132d | 0.287 | 74(75.5) | 48(77.4) | 0.076d | 0.782 | 49(69.0) | 81(82.7) | 4.314d | 0.038 | |
医保类型g | 0.056d | 0.972 | 1.602d | 0.449 | 0.224d | 0.894 | |||||||
城镇职工医疗保险 | 17(40.5) | 35(39.8) | 43(43.9) | 25(40.3) | 31(43.7) | 40(40.8) | |||||||
城镇居民医疗保险 | 12(28.6) | 24(27.3) | 23(23.5) | 11(17.7) | 14(19.7) | 22(22.4) | |||||||
其他 | 13(30.9) | 29(33.0) | 32(32.7) | 26(41.9) | 26(37.6) | 36(36.7) | |||||||
高血压病程f(年) | 8.8±5.0 | 10.0±6.3 | -1.113c | 0.268 | 10.9±6.1 | 10.5±5.6 | -0.381c | 0.703 | - | - | - | - | |
糖尿病病程f(年) | - | - | - | - | 9.0±5.0 | 8.1±4.6 | 1.139c | 0.256 | 7.4±4.6 | 9.8±5.0 | -3.180c | 0.002 | |
家中配备有血压计g | 36(85.7) | 75(85.2) | 0.005d | 0.941 | 89(90.8) | 52(83.9) | 1.750d | 0.186 | 59(83.1) | 83(84.7) | 0.078d | 0.780 | |
家中配备有血糖仪g | - | - | - | - | 69(70.4) | 35(56.5) | 3.251d | 0.071 | 42(59.2) | 69(70.4) | 2.313d | 0.128 | |
平素血压监测情况g | 1.172e | 0.241 | 0.949e | 0.343 | 0.829e | 0.407 | |||||||
不测 | 6(14.3) | 14(15.9) | 8(8.2) | 9(14.5) | 12(16.9) | 12(12.2) | |||||||
偶尔 | 14(33.3) | 40(45.5) | 49(50.0) | 30(48.4) | 34(47.9) | 47(48.0) | |||||||
经常 | 22(52.4) | 34(38.6) | 41(41.8) | 23(37.1) | 25(35.2) | 39(39.8) | |||||||
平素血糖监测情况g | - | - | 1.408e | 0.159 | 2.228e | 0.026 | |||||||
不测 | - | - | 19(19.4) | 16(25.8) | 18(25.4) | 18(18.4) | |||||||
偶尔 | - | - | 51(52.0) | 34(54.8) | 41(57.7) | 47(48.0) | |||||||
经常 | - | - | 28(28.6) | 12(19.4) | 12(16.9) | 33(33.7) | |||||||
收缩压f(mm Hg) | 131±5 | 153±13 | 13.862b | <0.001 | 132±6 | 153±11 | 13.983b | <0.001 | 138±13 | 140±13 | -0.793c | 0.429 | |
舒张压f(mm Hg) | 80±8 | 88±10 | -4.358c | <0.001 | 77±8 | 84±9 | -5.276c | <0.001 | 79±8 | 80±10 | -1.200c | 0.232 | |
空腹血糖f(mmol/L) | 5.47±0.51 | 5.54±0.58 | 0.739c | 0.462 | 7.8±2.3 | 7.9±2.4 | -0.309c | 0.758 | 6.08±0.62 | 9.09±2.26 | 12.549b | <0.001 |
Table 1 Comparison of hypertension control rate and/or glycemic control rate in population in the community with hypertension and/or diabetes and high risk of atherosclerotic cardiovascular disease by different characteristics
项目 | 单纯高血压患者(n=130) | 高血压合并糖尿病患者(n=160) | 患有糖尿病者a(n=169) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
血压控制达标组(n=42) | 血压控制未达标组(n=88) | 检验统计量值 | P值 | 血压控制达标组(n=98) | 血压控制未达标组(n=62) | 检验统计量值 | P值 | 血糖控制达标组(n=71) | 血糖控制未达标组(n=98) | 检验统计量值 | P值 | ||
年龄f(岁) | 67.0±6.5 | 61.7±9.3 | 3.758b | <0.001 | 65.4±5.7 | 62.9±7.7 | 2.203b | 0.031 | 63.9±6.2 | 64.9±6.8 | 0.979c | 0.329 | |
男性g | 28(66.7) | 70(79.5) | 2.541d | 0.111 | 52(53.1) | 38(61.3) | 1.045d | 0.307 | 41(57.7) | 54(55.1) | 0.117d | 0.732 | |
文化程度g | 0.032e | 0.975 | 0.811e | 0.417 | 0.250e | 0.802 | |||||||
本科及以上 | 4(9.5) | 7(8.0) | 5(5.1) | 5(8.1) | 3(4.2) | 7(7.1) | |||||||
高中或大专 | 16(38.1) | 31(35.2) | 45(45.9) | 23(37.1) | 31(43.7) | 38(38.8) | |||||||
中专或初中 | 13(31.0) | 37(42.0) | 31(31.6) | 18(29.0) | 21(29.6) | 35(35.7) | |||||||
小学及以下 | 9(21.4) | 13(14.8) | 17(17.3) | 16(25.8) | 16(22.5) | 18(18.4) | |||||||
深圳市户口g | 25(59.5) | 48(54.5) | 0.286d | 0.593 | 63(64.3) | 34(54.8) | 1.420d | 0.233 | 39(54.9) | 64(65.3) | 1.862d | 0.172 | |
吸烟g | 9(21.4) | 25(28.4) | 2.707d | 0.439 | 19(19.4) | 14(22.6) | 0.843d | 0.656 | 11(15.5) | 23(23.5) | 2.906d | 0.234 | |
对饮食的关注情况g | 1.633e | 0.103 | 0.692e | 0.489 | 1.173e | 0.241 | |||||||
不关注 | 9(21.4) | 37(42.0) | 32(32.6) | 20(32.3) | 21(29.6) | 34(34.7) | |||||||
一般关注 | 19(45.2) | 25(28.4) | 33(33.7) | 27(43.5) | 26(36.6) | 40(40.8) | |||||||
非常关注 | 14(33.3) | 26(29.5) | 33(33.7) | 15(24.2) | 24(33.8) | 24(24.5) | |||||||
规律运动g | 32(76.2) | 59(67.0) | 1.132d | 0.287 | 74(75.5) | 48(77.4) | 0.076d | 0.782 | 49(69.0) | 81(82.7) | 4.314d | 0.038 | |
医保类型g | 0.056d | 0.972 | 1.602d | 0.449 | 0.224d | 0.894 | |||||||
城镇职工医疗保险 | 17(40.5) | 35(39.8) | 43(43.9) | 25(40.3) | 31(43.7) | 40(40.8) | |||||||
城镇居民医疗保险 | 12(28.6) | 24(27.3) | 23(23.5) | 11(17.7) | 14(19.7) | 22(22.4) | |||||||
其他 | 13(30.9) | 29(33.0) | 32(32.7) | 26(41.9) | 26(37.6) | 36(36.7) | |||||||
高血压病程f(年) | 8.8±5.0 | 10.0±6.3 | -1.113c | 0.268 | 10.9±6.1 | 10.5±5.6 | -0.381c | 0.703 | - | - | - | - | |
糖尿病病程f(年) | - | - | - | - | 9.0±5.0 | 8.1±4.6 | 1.139c | 0.256 | 7.4±4.6 | 9.8±5.0 | -3.180c | 0.002 | |
家中配备有血压计g | 36(85.7) | 75(85.2) | 0.005d | 0.941 | 89(90.8) | 52(83.9) | 1.750d | 0.186 | 59(83.1) | 83(84.7) | 0.078d | 0.780 | |
家中配备有血糖仪g | - | - | - | - | 69(70.4) | 35(56.5) | 3.251d | 0.071 | 42(59.2) | 69(70.4) | 2.313d | 0.128 | |
平素血压监测情况g | 1.172e | 0.241 | 0.949e | 0.343 | 0.829e | 0.407 | |||||||
不测 | 6(14.3) | 14(15.9) | 8(8.2) | 9(14.5) | 12(16.9) | 12(12.2) | |||||||
偶尔 | 14(33.3) | 40(45.5) | 49(50.0) | 30(48.4) | 34(47.9) | 47(48.0) | |||||||
经常 | 22(52.4) | 34(38.6) | 41(41.8) | 23(37.1) | 25(35.2) | 39(39.8) | |||||||
平素血糖监测情况g | - | - | 1.408e | 0.159 | 2.228e | 0.026 | |||||||
不测 | - | - | 19(19.4) | 16(25.8) | 18(25.4) | 18(18.4) | |||||||
偶尔 | - | - | 51(52.0) | 34(54.8) | 41(57.7) | 47(48.0) | |||||||
经常 | - | - | 28(28.6) | 12(19.4) | 12(16.9) | 33(33.7) | |||||||
收缩压f(mm Hg) | 131±5 | 153±13 | 13.862b | <0.001 | 132±6 | 153±11 | 13.983b | <0.001 | 138±13 | 140±13 | -0.793c | 0.429 | |
舒张压f(mm Hg) | 80±8 | 88±10 | -4.358c | <0.001 | 77±8 | 84±9 | -5.276c | <0.001 | 79±8 | 80±10 | -1.200c | 0.232 | |
空腹血糖f(mmol/L) | 5.47±0.51 | 5.54±0.58 | 0.739c | 0.462 | 7.8±2.3 | 7.9±2.4 | -0.309c | 0.758 | 6.08±0.62 | 9.09±2.26 | 12.549b | <0.001 |
原因 | 血压控制未达标组(n=150) | 空腹血糖控制未达标组(n=98) |
---|---|---|
持顺其自然态度 | 76(50.7) | 32(32.7) |
持无能为力态度 | 30(20.0) | 18(18.4) |
药物使用问题 | 30(20.0) | 24(24.5) |
条件限制 | 19(12.7) | 5(5.1) |
医生因素 | 18(12.0) | 22(22.4) |
缺乏自制力 | 16(10.7) | 30(30.6) |
其他 | 8(5.3) | 3(3.1) |
Table 2 Common reasons for inadequate hypertension control rate and/or inadequate glycemic control rate in population in the community with hypertension and/or diabetes and high risk of atherosclerotic cardiovascular disease
原因 | 血压控制未达标组(n=150) | 空腹血糖控制未达标组(n=98) |
---|---|---|
持顺其自然态度 | 76(50.7) | 32(32.7) |
持无能为力态度 | 30(20.0) | 18(18.4) |
药物使用问题 | 30(20.0) | 24(24.5) |
条件限制 | 19(12.7) | 5(5.1) |
医生因素 | 18(12.0) | 22(22.4) |
缺乏自制力 | 16(10.7) | 30(30.6) |
其他 | 8(5.3) | 3(3.1) |
[1] | 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要[J]. 中国循环杂志,2020,35(9):833-854. DOI:10.3969/j.issn.1000-3614.2020.09.001. |
[2] | 国家卫生健康委员会. 国家基本公共卫生服务规范(第三版)[EB/OL]. (2017-02-28)[2021-07-11]. . |
[3] | 姚建森. 山东省2型糖尿病社区管理效果及影响因素研究[D]. 济南:山东大学,2020. |
[4] | 姜巍,张艳春,董亚丽,等. 我国基层卫生改革措施对糖尿病管理效果的影响研究[J]. 中国全科医学,2020,23(16):2067-2071,2079. DOI:10.12114/j.issn.1007-9572.2020.00.345. |
[5] | 曾望远,周素云,顾申红. 海口市社区高血压现状调查及全科干预效果研究[J]. 中国全科医学,2020,23(18):2335-2341. DOI:10.12114/j.issn.1007-9572.2020.00.328. |
[6] | 王心怡,孙瑾. 基于自我效能感评估的家庭访谈对高龄高血压患者自我管理能力和血压控制效果的影响[J]. 山西医药杂志,2019,48(23):3008-3011. |
[7] | YANG X L,LI J X,HU D S,et al. Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population:the China-PAR Project(prediction for ASCVD risk in China)[J]. Circulation,2016,134(19):1430-1440. DOI:10.1161/CIR.116.022367. |
[8] | 尹朝霞,罗友连,谢东风,等. 动脉粥样硬化性心血管疾病高危人群疾病认知及需求的质性研究[J]. 中华全科医师杂志,2020,19(8):728-731. |
[9] | 胡哲,丰青,邓雪芹,等. 上海嘉定区高血压控制情况及其影响因素[J]. 上海交通大学学报(医学版),2020,40(12):1652-1655. DOI:10.3969/j.issn.1674-8115.2020.12.015. |
[10] | 中华医学会内分泌学分会. 糖尿病患者血糖波动管理专家共识[J]. 药品评价,2017,14(17):5-14. DOI:1672-2809(2017)17-0005-05. |
[11] | 葛彩英,孔憨,赵新颖,等. 家庭自测血压对高血压患者血压达标和血压波动性的评价研究[J]. 中国全科医学,2012,15(9):2884-2888. DOI:10.3969/j.issn.1007-9572.2012.09.010. |
[12] | 杨连招,杨永,张瑛,等. 老年高血压患者服药依从性现状及干预研究进展[J]. 中国全科医学,2016,19(29):3619-3623.DOI:10.3969/j.issn.1007-9572.2016.29.024. |
[13] | 于晓松,路孝琴. 全科医学概论[M]. 北京:人民卫生出版社,2018:108. |
[14] | GRUNDY S M,STONE N J,BAILEY A L,et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines[J]. Circulation,2019,139(25):e1082-1143. DOI:10.1161/CIR.0000000000000625. |
[15] | HOWRENA M B,VANDER WEGA M W,CHRISTENSENE A J,et al. Association of patient preferences on medication discussion in hypertension:results from a randomized clinical trial[J]. Soc Sci Med,2020,262(10):1-7. DOI:10.1016/j.socscimed.2020.113244. |
[16] | VINA E R,QUINONES C. Understanding the role and challenges of patient preferences in disparities in rheumatologic disease care[J]. Rheum Dis Clin NAm,2021,47(1):83-96. DOI: 10.1016/j.rdc.2020.09.003. |
[17] | 陈倩,冯磊. 我国基层医疗卫生机构患者安全问题及其解决路径研究[J]. 中国全科医学,2021,24(13):1585-1591. DOI:10.12114/j.issn.1007-9572.2021.00.177. |
[18] | 秦江梅,林春梅,张丽芳,等. 基层卫生综合改革重点联系区县患者基层就诊满意度研究[J]. 中国全科医学,2018,21(1):36-40. DOI:10.3969/j.issn.1007-9572.2018.01.009. |
[19] | 吕兰婷,林筑,张延. 我国慢性病防控与管理研究的十年综述[J]. 中国卫生事业管理,2020,37(1):32-34,37. |
[20] | 高其法,宋剑,丁立松. 慢性病患者的支点作用与慢性病防控:基于知信行模型的观点[J]. 中国全科医学,2012,15(6):1858-1860. DOI:10.3969/j.issn.1007-9572.2012.06.025. |
[21] | 国务院医改办. 关于推进家庭医生签约服务的指导意见[EB/OL]. (2016-05-25)[2021-07-26]. . |
[22] | 范转转,刘圆圆,杨倩,等. 我国家庭医生签约服务存在的问题研究[J]. 卫生经济研究,2018,11(25):54-56. |
[1] | LI Dianjiang, PAN Enchun, SUN Zhongming, WEN Jinbo, WANG Miaomiao, WU Ming, SHEN Chong. The Current Status and Influencing Factors of Clinical Inertia in Type 2 Diabetes Patients in Community [J]. Chinese General Practice, 2023, 26(34): 4296-4301. |
[2] | LIN Kai, YAO Mi, CHEN Zhang, JI Xinxin, LIN Runqi, CHEN Yongsong, Sim MOIRA. Conceptual Framework and Responding Approach of Treatment Burden of Type 2 Diabetes: a Video Recording-based Analysis [J]. Chinese General Practice, 2023, 26(34): 4302-4307. |
[3] | YANG Hui, HU Ruwei, LIU Ruqing, LU Junfeng, WU Jinglan. Relationship between Community Health Service Experience and Glycemic Control Outcomes in Patients with Diabetes Mellitus [J]. Chinese General Practice, 2023, 26(34): 4290-4295. |
[4] | WANG Jie, LI Shiming, WEI Shifei, WANG Ningli. Importance of the Role of Primary Care in Myopia Prevention and Control Behavioral Intervention among Children [J]. Chinese General Practice, 2023, 26(33): 4213-4217. |
[5] | ZHANG Juan, LI Haifen, LI Xiaoman, YAO Miao, MA Huizhen, MA Qiang. Construction of Recurrence Risk Prediction Model for Diabetic Foot Ulcer on the Basis of Logistic Regression, Support Vector Machine and BP Neural Network Model [J]. Chinese General Practice, 2023, 26(32): 4013-4019. |
[6] | ZHANG Shuai, LI Qin, LI Dongfeng, XIAO Jinping, LI Yunpeng. A Prospective Cohort Study of Solid Fuels Use and Risk of Hypertension in Chinese Older Adults [J]. Chinese General Practice, 2023, 26(32): 4001-4006. |
[7] | LIU Rui, CAO Yu, CHU Aiqun, WU Huanyun. Current Situation of Community Pharmacy Services and the Integration of Pharmacists into Family Doctor Team in Shanghai [J]. Chinese General Practice, 2023, 26(31): 3922-3929. |
[8] | CHENG Jingwei, QIAO Junjun, YIN Zhen, HU Junpeng, WANG Qinghe, LIU Yangqing, WANG Yanfang. Interpretation of ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in Children and Adolescents with Diabetes [J]. Chinese General Practice, 2023, 26(30): 3719-3724. |
[9] | ZHOU Xiaoqi, LIU Xinhui, ZHANG Wei, LI Changfeng, YAN Yaqiong. Association of Alanine Transaminase and Aspartate Aminotransferase/Alanine Transaminase Ratio with Type 2 Diabetes and Metabolic Syndrome in the Elderly [J]. Chinese General Practice, 2023, 26(29): 3645-3649. |
[10] | XIAO Liqi, YANG Li, CUI Saixian, ZHANG Yayuan, WANG Yulu, HE Yan. Advances in the Association of High Salt-induced Gut Microbiota Disturbances with Salt-sensitive Blood Pressure [J]. Chinese General Practice, 2023, 26(29): 3704-3709. |
[11] | ZHAO Xiaohua, DU Lin, GAO Shengnan, JIANG Ziyun. Multiple Deep Muscle Abscesses in Type 2 Diabetes in the Elderly: Report of One Case and Literature Review [J]. Chinese General Practice, 2023, 26(29): 3715-3718. |
[12] | CHENG Xiaoran, ZHANG Xiaotian, LI Mingyue, CHENG Haozhe, TANG Haoqing, ZHENG Huixian, ZHANG Baisong, LIU Xiaoyun. Impact of Chronic Diseases Follow-up on Health Behaviors and Blood Pressure/Glucose Control of Patients with Hypertension and Diabetes in the Context of Treatment-prevention Integration [J]. Chinese General Practice, 2023, 26(28): 3482-3488. |
[13] | BIAN Lili, LI Xiaoxiao, DU Xueping, DAI Qinfang, WU Lin, SONG Beibei. Risk Stratification of Atherosclerotic Cardiovascular Disease and Lipid Goal Attainment in Hypertensive Patients Registered in Community [J]. Chinese General Practice, 2023, 26(27): 3388-3391. |
[14] | LUO Dan, XU Jingjing, WANG Yubing, LI Mingzi, FORBES Angus. Development and Preliminary Practice of Resilience-oriented Structured Treatment and Educational Program for Adolescents with Type 1 Diabetes [J]. Chinese General Practice, 2023, 26(27): 3423-3429. |
[15] | DONG Yanan, JIANG Xiaorui, WANG Kai, ZONG Chuanchong, LIN Guodong, LI Xiangqing, LIN Chunxiao, CHI Juntao. The Effect of Modified Tibial Transverse Transport Technique in the Treatment of Wagner Grade Ⅲ and Ⅳ Diabetic Foot Patients [J]. Chinese General Practice, 2023, 26(27): 3411-3416. |
Viewed | ||||||||||||||||||||||||||||||||||||||||||||||||||
Full text 665
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||
Abstract 1061
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||