上海市某社区高血压患者全因死亡影响因素探讨  

Risk factors for all-cause mortality of hypertensive patients in a community in Shanghai

作　　者：张红梅[1] 陈凌[1] 王亚娟[1] 苗苗 冷海燕[1] 阮铁梅 唐晓颖 蔡兰平[1] 王彦[2] 冯雨 郑普阳 Zhang Hongmei;Chen Ling;Wang Yajuan;Miao Miao;Leng Haiyan;Ruan Tiemei;Tang Xiaoying;Cai Lanping;Wang Yan;Feng Yu;Zheng Puyang(Shanghai Xinzhuang Community Health Service Centre of Minhang District,Shanghai 201199,China;Shanghai Institute of Hypertension,Department of Hypertension,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海市闵行区莘庄社区卫生服务中心,上海201199 [2]上海交通大学医学院附属瑞金医院高血压科,上海市高血压研究所,上海200025

出　　处：《中华全科医师杂志》2024年第10期1037-1043,共7页Chinese Journal of General Practitioners

基　　金：上海市闵行区公共卫生重点学科(MGWXK2023-06)。

摘　　要：目的探讨社区高血压患者全因死亡的影响因素。方法该研究为回顾性队列研究。纳入2012年1至12月在上海市闵行区莘庄镇社区卫生服务中心参与免费健康体检的高血压患者,根据随访过程中是否发生死亡,分为死亡组和存活组。收集入选者的基线临床资料。全因死亡为本研究的终点事件,终点事件收集截止时间为2022年12月31日。采用多因素Cox回归模型分析社区高血压患者全因死亡的独立影响因素。结果纳入高血压患者4049例,年龄(67.9±7.1)岁,男性1856例(45.8%),其中死亡组610例、存活组3439例。多因素Cox回归分析结果显示,男性(HR=1.446,95%CI:1.200~1.742,P<0.001)、年龄(HR=1.130,95%CI:1.118~1.143,P<0.001)、腰高比(HR=8.117,95%CI:2.235~29.481,P=0.001)、尿蛋白阳性(HR=2.974,95%CI:2.202~4.016,P<0.001)、空腹血糖(HR=1.070,95%CI:1.012~1.131,P=0.017)、卒中史(HR=1.819,95%CI:1.414~2.340,P<0.001)是社区高血压患者全因死亡的独立危险因素,而每周运动≥1次(HR=0.816,95%CI:0.668~0.996,P=0.046)、服用调脂药物(HR=0.459,95%CI:0.223~0.947,P=0.035)是社区高血压患者全因死亡的独立保护因素。结论男性、年龄、腰高比、尿蛋白阳性、空腹血糖、卒中史是社区高血压患者全因死亡的独立危险因素,而每周运动≥1次、服用调脂药物是其独立保护因素。Objective To explore the risk factors of all-cause death in hypertensive patients in the community.Methods A cohort of 4049 hypertensive patients who participated in annual health checkups at Xinzhuang Community Health Service Centre of Shanghai Minhang district from January to December 2012 were enrolled in the study.All-cause death was the endpoint event of this study,and patients were divided into a fatal group and a survival group.The collection date for the endpoint event was December 2022.A multivariate Cox regression model was used to analyse the independent risk factors of all-cause mortality among hypertensive patients in the community.Results Among 4049 patients aged(67.9±7.1)years,1856(45.8%)were males.There were 610 cases in the fatal group and 3439 cases in the survival group.Multivariate Cox proportional regression showed that male gender(HR=1.446,95%CI:1.200-1.742,P<0.001),older age(HR=1.130,95%CI:1.118-1.143,P<0.001),higher waist-to-height ratio(HR=8.117,95%CI:2.235-29.481,P=0.001),positive urinary protein(HR=2.974,95%CI:2.202-4.016,P<0.001),high fasting blood glucose(HR=1.070,95%CI:1.012-1.131,P=0.017),and history of stroke(HR=1.819,95%CI:1.414-2.340,P<0.001)were independent risk factors for all-cause mortality in hypertensive patients,while exercise≥1/week(HR=0.816,95%CI:0.668-0.996,P=0.046)and taking lipid-lowering medications(HR=0.459,95%CI:0.223-0.947,P=0.035)were protective factors for all-cause mortality.Conclusion For hypertensive patients,male gender,older age,higher waist-to-height ratio,positive urinary protein,high fasting blood glucose,and history of stroke are risk factors for all-cause mortality,while exercise≥1/week and taking lipid-lowering medications are protective factors.

关 键 词：高血压 死亡 影响因素 

分 类 号：R544.1[医药卫生—心血管疾病]