上海市社区管理高血压患者诊室血压标准化测量中双臂血压差异流行现状及影响因素分析  

Analysis of inter-arm blood pressure difference and its influencing factors in clinical standardized blood pressure measurement among hypertensive patients managed by community health center in Shanghai

作　　者：吴菲 严青华[1] 王玉恒[1] 张晟 程旻娜[1] 施燕[1,2] WU Fei;YAN Qing-hua;WANG Yu-heng;ZHANG Sheng;CHENG Min-na;SHI Yan(Division of Chronic Non-communicable Disease and Injury,Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China;不详)

机构地区：[1]上海市疾病预防控制中心慢性非传染病与伤害防治所,上海200336 [2]国家老年疾病临床医学研究中心

出　　处：《中国慢性病预防与控制》2022年第9期682-686,691,共6页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：上海市加强公共卫生体系建设三年行动计划(2020—2022年)(GWV-7);上海市公共卫生体系建设三年行动计划学科建设项目(GWV-10.1-XK05)。

摘　　要：目的 了解上海市社区管理高血压患者诊室血压标准化测量中双臂血压差异流行情况及影响因素,为进一步探索经济高效的高血压并发症筛查模式提供数据支持。方法 本研究数据来源于上海市社区慢性病健康管理信息系统和标准化测压数据存储系统。选取2020年1月1日至12月31日既接受社区卫生服务中心高血压随访管理同时又进行双臂血压标准化测量的对象,共匹配7 526人,分布在上海市9个区18个社区卫生服务中心。收集管理信息,并进行双臂血压测量。采用SAS 9.4软件进行t检验、Wilcoxon秩和检验、χ^(2)检验和多因素逐步logistic回归分析。结果 上海市社区管理高血压患者双臂收缩压差值异常发生率为29.50%,双臂舒张压差值异常发生率为6.83%。多因素logistic回归分析结果显示,年龄(OR=1.014)、女性(OR=1.156)、体质指数(OR=1.015)、冬季测压(OR=1.269)与双臂收缩压差值异常高风险相关,城乡结合地区(OR=0.633)与双臂收缩压差值异常低风险相关,均有统计学意义(P<0.05,P<0.01)。年龄(OR=1.011)、女性(OR=1.377)、城市地区(OR=1.597)以及体质指数(OR=1.028)与双臂舒张压差值异常高风险相关;与夏季测量血压相比,春季测量血压与双臂舒张压差值异常低风险相关(OR=0.703),均有统计学意义(P<0.05,P<0.01)。结论 上海市社区管理高血压患者双臂血压差值异常的发生率较高,应当重点监测年龄大、女性、体质指数高、城市地区以及冬季时的高血压患者的双臂血压,从而预防相关的心脑血管疾病的发生。Objective To understand the inter-arm blood pressure difference(IAD) and its influencing factors in clinical standardized blood pressure measurement among hypertensive patients managed by community health center in Shanghai,and provide the data support for exploring the economic and effective screening model of hypertension complications. Methods Data were from Shanghai chronic disease management system and standardized blood pressure system.A total of 7 526 hypertensive patients,who were followed up and conducted their bilateral blood pressure measurement from January 1 to December 31,2020,were selected as the subjects in 18 community health service centers of 9 districts. The management information was collected,and two arms blood pressures were measured. The t test,Wilcoxon sum rank test,χ^(2)test and the multiple-varied logistic regression method were used to analyze the data. Results The morbidity rates of abnormal systolic IAD and diastolic IAD were 29.50% and6.83%,respectively. Multivariate stepwise logistic regression analysis showed that age(OR=1.014),female(OR=1.156),body mass index(OR=1.015) and measurement in winter(OR=1.269) were associated with high risk of abnormal systolic IAD. The residents in areas between urban and rural regions(OR=0.633) was correlated with low risk of abnormal systolic IAD,P<0.05 or P<0.01.The age(OR=1.011),female(OR=1.377),urban area(OR=1.597) and body mass index(OR=1.028) were correlated with high risk of abnormal diastolic IAD;as compared with measurement in summer,the measurement in spring was correlated with low risk of abnormal diastolic IAD(OR=0.703),P<0.05 or P<0.01. Conclusion The morbidity of abnormal IAD in hypertensive patients managed by community in Shanghai is relatively high. It should monitor the IAD in residents with high age,female,high body mass index,in urban area and in winter to prevent the occurrence of related cardiovascular and cerebrovascular diseases.

关 键 词：高血压 双臂血压差异 诊室血压 社区管理 

分 类 号：R544.1[医药卫生—心血管疾病]