深圳市社区高血压患者缺血性心血管病发病风险状况

来源 :中华健康管理学杂志 | 被引量 : 0次 | 上传用户:tiaozhanwudeshou
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目的:掌握深圳市社区高血压患者缺血性心血管病(ICVD)10年发病风险状况,为全面推行基于ICVD风险评估的社区高血压健康管理措施提供基线数据。方法:2017年7月—2018年6月,采用多阶段随机抽样,在深圳市10个区抽取200家社区健康服务中心,选取纳入社区规范化管理、年龄≥35岁的高血压患者。对于符合纳入排除标准的患者,收集其人口学特征、体格检查和实验室检测等指标,应用深圳社区健康服务信息系统ICVD发病高危评估模块,评估ICVD 10年发病绝对危险度,估算和分析不同特征人群ICVD 10年发病风险等级。另外,选取35~59岁患者与自然人群比较,分析相对危险度。结果:共调查30 015例社区高血压患者,其中男性16 165例(53.86%),女性13 850例(46.14%);年龄35~102岁,中位年龄59岁。ICVD10年发病绝对危险度为3.77%,95%n CI为3.72%~3.82%;高危6 405例(21.34%),中危5 771例(19.23%),低危17 839例(59.43%)。男性、已婚、流动人口、总胆固醇<5.20 mmol/L、不吸烟、无糖尿病、有高血压家族史的高血压患者ICVD发病风险等级较对应其他特征患者低,且随年龄、收缩压和体质指数增加,高危风险等级增大(n P均<0.001)。选取15 652例35~59岁患者分析发现,社区高血压患者ICVD 10年发病风险较自然人群略高,相对危险度为1.27,95%n CI为1.25~1.28(n t=37.648,n P<0.001)。其中,男性相对危险度为0.94,95%n CI为0.93~0.95(n t=9.906,n P<0.001),各年龄段相差不大;女性相对危险度为2.05,95%n CI为2.01~2.09(n t=72.207,n P<0.001),且随年龄增加呈上升趋势。n 结论:深圳市社区高血压患者ICVD10年发病风险尚处于较高水平,在社区管理的高血压患者中开展ICVD风险评估仍有必要。社区高血压健康管理降低ICVD发病风险的效果可能在性别间存在差异,男性患者ICVD发病风险已低于男性自然人群,而女性患者仍远高于女性自然人群。“,”Objective:To understand the 10-year risk of ischemic cardiovascular disease (ICVD) in hypertensive patients in communities in Shenzhen, and to provide baseline data for the comprehensive implementation of community-based hypertension health management measures based on ICVD risk assessment.Methods:From July 2017 to June 2018, 200 community health service centers in 10 districts of Shenzhen were selected by multi-stage random sampling to investigate hypertensive patients in communities aged≥35. After the patients who met the inclusion criteria signed the informed consent form, the demographic characteristics, physical examination, and laboratory tests were conducted. The absolute risk of ICVD in 10 years was evaluated by using the ICVD risk assessment module from the Shenzhen community health service information system. According to the China 10-year risk for ICVD score tables, recommended by the Chinese cardiovascular disease prevention guidelines, the risk grade of ICVD was estimated and analyzed. In addition, the relative risk was used to eliminate the influence of gender and age, and the single sample n t-test was used for comparisons with the larger population.n Results:30 015 hypertensive patients from communities were investigated, including 16 165 (53.86%) males and 13 850 (46.14%) females, aged 35-102 years, with a median age of 59.0. 6 405 (21.34%), 5 771 (19.23%) and 17 839 (59.43%) were at high, medium and low risk of ICVD, respectively. The absolute risk was 3.77%, 95% n CI (3.72%-3.82%). The risk grades of ICVD in 10 years was different as per gender, age, marital status, population type, smoking, family history of hypertension, history of diabetes mellitus, systolic blood pressure, body mass index, and total cholesterol level,n P values were all<0.001. The risk grades of ICVD in males, married patients, floating populations, having a total cholesterol <5.20 mmol/L, non-smokers, non-diabetics, and having a family history of hypertension were lower than that of other characteristics, and increased with age, systolic blood pressure, and body mass index. Further analysis of 15 652 patients aged 35-59 years old showed that the 10-year risk of ICVD in patients with hypertension in communities was slightly higher than that of the larger population, and the relative risk was 1.27, 95%n CI (1.25-1.28), n t=37.648, n P<0.001. In males, relative risk was 0.94, 95%n CI (0.93-0.95), n t= 9.906, n P<0.001, and there were no significant trend changes among age groups. In females, relative risk was 2.05, 95%n CI (2.01-2.09), n t=72.207, n P<0.001, and increased with age.n Conclusion:The 10-year risk of ICVD in hypertensive patients is often at a high level in Shenzhen, so it is necessary to carry out the risk assessment of ICVD in the community. The effect of community hypertension health management on reducing the risk of ICVD may vary between genders. The risk of ICVD in male patients is lower than that of males in the larger population, but in female patients it is still much higher.
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