我国西南地区年龄35～75岁成人高血压知晓、治疗和控制现状
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摘要
目的描述我国西南地区成人高血压的知晓、治疗和控制现状,探究其与个体特点的关联,并分析高血压药物使用情况。方法研究基于"心血管病高危人群早期筛查与综合干预项目"。采用方便抽样的方法,自2016年1月至2017年12月于我国西南地区对年龄35～75岁成人进行筛查。纳入符合入选标准的调查对象,收集其基本信息,进行血压测量等体格检查,并完成调查问卷。高血压的定义为收缩压≥140和(或)舒张压≥90 mm Hg,或在过去两周内服用降压药物,或自报高血压病史;高血压知晓、治疗和控制的定义分别为高血压患者自报既往被诊断过高血压,服用降压药物,以及收缩压<140且舒张压<90 mm Hg。研究描述不同人群分组的高血压患病情况及知晓、治疗和控制率,并利用混合模型探究其与个体特点的关系,同时分析高血压患者的常用降压药物使用情况和用药模式。结果研究共纳入315 250名对象,38.5%为男性,年龄(55.2±10.3)岁,平均血压133.4/80.9 mm Hg,其中高血压患者占40.4%(127 231/315 250)。高血压知晓、治疗和控制率分别为42.3%(53 821/127 231),27.8%(35 382/127 231)和8.9%(11 305/127 231)。女性的高血压知晓、治疗率高于男性;年龄,家庭年收入,受教育程度,有糖尿病或既往心脑血管事件与高血压知晓、治疗和控制率呈正相关,而饮酒呈负相关;肥胖和吸烟分别与高血压知晓、治疗率和知晓、控制率呈正相关(均P<0.05)。服用降压药物的高血压患者中,86.8%只服用1种降压药物,仅1.3%服用3种及以上降压药物。钙拮抗剂使用最广泛(49.0%),最常见的联合用药为血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂联合钙拮抗剂(35.7%)。结论我国西南地区成人高血压知晓、治疗和控制情况不容乐观,联合用药率低。全面开展高血压预防宣教、提高筛查率和诊治水平是当务之急。
Objective To describe the awareness, treatment and control of hypertension in adults in Southwest China and investigate relevant personal characteristics, as well as the usage of antihypertensive medicine among patients with hypertension. Methods The data from a population-based high risk cardiovascular screening study named China PEACE(Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project in Southwest China, collected from January 2016 to December 2017, was used. Basic information, physical examination and questionnaire were collected. In this population, hypertension was defined as systolic blood pressure(SBP) ≥140 mm Hg and/or diastolic blood pressure(DBP) ≥90 mm Hg, or self-reported antihypertensive medication use in the previous 2 weeks or history of hypertension. Hypertension awareness, treatment and control were defined respectively among hypertensive adults as a self-reported diagnosis of hypertension, current use of antihypertensive medication and blood pressure ≤140/90 mm Hg. The prevalence, awareness, treatment and control rates of hypertension in subgroups were assessed, and the associations of hypertension management with individual characteristics was identified using mixed models. The number and pattern of medication use were also investigated. Results The sample contained 315 250 participants with a mean age of(55.2±10.3) years, 38.5% of whom were males. The average blood pressure was 133.4/80.9 mm Hg, and 127 231 had hypertension, of whom 42.3% were aware of their diagnosis, 27.8% were under antihypertensive medications treatment, and 8.9% had achieved control. Women had higher awareness and treatment rates than men(P<0.001). Age, income, education, diabetes or previous cardiovascular events had a positive correlation, while alcohol use had a negative correlation with awareness, treatment and control rates; positive correlation also could be seen in obesity with awareness and treatment as well as smoking with awareness and control(all P<0.05). Among patients under treatment, only 86.8% took one hypertensive medicine and only 1.3% took three or more. The most commonly used medication class was calcium channel blocker(CCB)(49.0%). Angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB) plus CCB(35.7%) was the commonest combination therapy. Conclusion Hypertension awareness, treatment and control in community-dwelling residents are poor in Southwest China, and the proportion of medicine combination therapy is low. It is our top priority to improve hypertension prevention instruction, better hypertension screening, and promote effective and affordable treatment.
Objective To describe the awareness, treatment and control of hypertension in adults in Southwest China and investigate relevant personal characteristics, as well as the usage of antihypertensive medicine among patients with hypertension. Methods The data from a population-based high risk cardiovascular screening study named China PEACE(Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project in Southwest China, collected from January 2016 to December 2017, was used. Basic information, physical examination and questionnaire were collected. In this population, hypertension was defined as systolic blood pressure(SBP) ≥140 mm Hg and/or diastolic blood pressure(DBP) ≥90 mm Hg, or self-reported antihypertensive medication use in the previous 2 weeks or history of hypertension. Hypertension awareness, treatment and control were defined respectively among hypertensive adults as a self-reported diagnosis of hypertension, current use of antihypertensive medication and blood pressure ≤140/90 mm Hg. The prevalence, awareness, treatment and control rates of hypertension in subgroups were assessed, and the associations of hypertension management with individual characteristics was identified using mixed models. The number and pattern of medication use were also investigated. Results The sample contained 315 250 participants with a mean age of(55.2±10.3) years, 38.5% of whom were males. The average blood pressure was 133.4/80.9 mm Hg, and 127 231 had hypertension, of whom 42.3% were aware of their diagnosis, 27.8% were under antihypertensive medications treatment, and 8.9% had achieved control. Women had higher awareness and treatment rates than men(P<0.001). Age, income, education, diabetes or previous cardiovascular events had a positive correlation, while alcohol use had a negative correlation with awareness, treatment and control rates; positive correlation also could be seen in obesity with awareness and treatment as well as smoking with awareness and control(all P<0.05). Among patients under treatment, only 86.8% took one hypertensive medicine and only 1.3% took three or more. The most commonly used medication class was calcium channel blocker(CCB)(49.0%). Angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB) plus CCB(35.7%) was the commonest combination therapy. Conclusion Hypertension awareness, treatment and control in community-dwelling residents are poor in Southwest China, and the proportion of medicine combination therapy is low. It is our top priority to improve hypertension prevention instruction, better hypertension screening, and promote effective and affordable treatment.
引文
[1] 国家心血管病中心.中国心血管病报告2017[M].北京:中国大百科全书出版社,2018.
[2] Bundy JD,He J.Hypertension and related cardiovascular disease burden in China[J].Ann Glob Health,2016,82(2):227-233.
[3] 国家卫生计生委疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[M].北京:人民卫生出版社,2015.
[4] Lu J,Lu Y,Wang X,et al.Prevalence,awareness,treatment,and control of hypertension in China:data from 1.7 million adults in a population-based screening study (China PEACE million persons project)[J].Lancet,2017,390(10112):2549-2558.
[5] Fang L,Song J,Ma Z,et al.Prevalence and characteristics of hypertension in mainland Chinese adults over decades:a systematic review[J].J Hum Hypertens,2014,28(11):649-656.
[6] Guo J,Zhu YC,Chen YP,et al.The dynamics of hypertension prevalence,awareness,treatment,control and associated factors in Chinese adults:results from CHNS 1991-2011[J].J Hypertens,2015,33(8):1688-1696.
[7] Dong F,Wang D,Pan L,et al.Disparities in hypertension prevalence,awareness,treatment and control between Bouyei and Han:results from a bi-ethnic health survey in developing regions from South China[J].Int J Envir Res Pub Health,2016,13(2):233.
[8] Zhao X,Li S,Ba S,et al.Prevalence,awareness,treatment,and control of hypertension among herdsmen living at 4300 m in Tibet[J].Am J Hypertens,2012,25(5):583-589.
[9] Gu H,Li W,Yang J,et al.Hypertension prevalence,awareness,treatment and control among Han and four ethnic minorities (Uygur,Hui,Mongolian and Dai) in China[J].J Hum Hypertens,2015,29(9):555-560.
[10] Cai L,Dong J,Cui WL,et al.Socioeconomic differences in prevalence,awareness,control and self-management of hypertension among four minority ethnic groups,Na Xi,Li Shu,Dai and Jing Po,in rural southwest China[J].J Hum Hypertens,2017,31(6):388-394.
[11] Chen L,Zong Y,Wei T,et al.Prevalence,awareness,medication,control,and risk factors associated with hypertension in Yi ethnic group aged 50 years and over in rural China:the Yunnan minority eye study[J].BMC Public Health,2015,15:383.
[12] 陈邕,王嘉凌,陈庆宪.2002-2004年西南地区62家医院抗高血压药利用分析[J].中国药房,2005,16(22):1718-1720.
[13] 聂静雨,张林峰,陈祚,等.社区人群中高血压患者的用药情况分析[J].中华高血压杂志,2017,25(10):956-960.
[14] Lu J,Xuan S,Downing NS,et al.Protocol for the China PEACE (patient-centered evaluative assessment of cardiac events) million persons project pilot[J].BMJ Open,2016,6(1):e010200.
[15] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[16] James PA,Oparil S,Carter BL,et al.2014 evidence-based guideline for the management of high blood pressure in adults:Report from the panel members appointed to the eighth joint national committee (JNC8)[J].JAMA,2014,311(5):507-520.
[17] 国务院人口普查办公室,国家统计局人口和就业统计司.中国2010年人口普查资料[DB/OL].2018-09-12.http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm.
[18] 王卓群,杨静,赵艳芳.2010年中国西部地区成人高血压流行现状分析[J].中国预防医学杂志,2014,15(3):241-244.
[19] Li D,Lv J,Liu F,et al.Hypertension burden and control in mainland China:analysis of nationwide data 2003-2012[J].Int J Cardiol,2015,184:637-644.
[20] 李镒冲.我国高血压患病、知晓、治疗和控制的多水平空间分析[D].中国疾病预防控制中心,2016.
[21] Wang W,Jiang B,Sun H,et al.Prevalence,incidence,and mortality of stroke in China:results from a nationwide population-based survey of 480 687 adults[J].Circulation,2017,135(8):759-771.
[22] Ma WJ,Tang JL,Zhang YH,et al.Hypertension prevalence,awareness,treatment,control,and associated factors in adults in southern China[J].Am J Hypertens,2012,25(5):590-596.
[23] Yang L,Yan J,Tang X,et al.Prevalence,awareness,treatment,control and risk factors associated with hypertension among adults in Southern China,2013[J].PLoS One,2016,11(1):e0146181.
[24] Le C,Jun D,Yichun L,et al.Multilevel analysis of the determinants of pre-hypertension and hypertension in rural southwest China[J].Public Health Rep,2011,126(3):420-427.
[25] Wang JG,Li Y.Characteristics of hypertension in Chinese and their relevance for the choice of antihypertensive drugs[J].Diabetes Metab Res Rev,2012,28 Suppl 2:67-72.
[26] European Society of Cardiology (ESC),European Society of Hypertension (ESH).First look at the new 2018 European guidelines for the treatment of high blood pressure[DB/OL].[2018-06-09].http://www.eshonline.org/esh-annual-meeting/.
[2] Bundy JD,He J.Hypertension and related cardiovascular disease burden in China[J].Ann Glob Health,2016,82(2):227-233.
[3] 国家卫生计生委疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[M].北京:人民卫生出版社,2015.
[4] Lu J,Lu Y,Wang X,et al.Prevalence,awareness,treatment,and control of hypertension in China:data from 1.7 million adults in a population-based screening study (China PEACE million persons project)[J].Lancet,2017,390(10112):2549-2558.
[5] Fang L,Song J,Ma Z,et al.Prevalence and characteristics of hypertension in mainland Chinese adults over decades:a systematic review[J].J Hum Hypertens,2014,28(11):649-656.
[6] Guo J,Zhu YC,Chen YP,et al.The dynamics of hypertension prevalence,awareness,treatment,control and associated factors in Chinese adults:results from CHNS 1991-2011[J].J Hypertens,2015,33(8):1688-1696.
[7] Dong F,Wang D,Pan L,et al.Disparities in hypertension prevalence,awareness,treatment and control between Bouyei and Han:results from a bi-ethnic health survey in developing regions from South China[J].Int J Envir Res Pub Health,2016,13(2):233.
[8] Zhao X,Li S,Ba S,et al.Prevalence,awareness,treatment,and control of hypertension among herdsmen living at 4300 m in Tibet[J].Am J Hypertens,2012,25(5):583-589.
[9] Gu H,Li W,Yang J,et al.Hypertension prevalence,awareness,treatment and control among Han and four ethnic minorities (Uygur,Hui,Mongolian and Dai) in China[J].J Hum Hypertens,2015,29(9):555-560.
[10] Cai L,Dong J,Cui WL,et al.Socioeconomic differences in prevalence,awareness,control and self-management of hypertension among four minority ethnic groups,Na Xi,Li Shu,Dai and Jing Po,in rural southwest China[J].J Hum Hypertens,2017,31(6):388-394.
[11] Chen L,Zong Y,Wei T,et al.Prevalence,awareness,medication,control,and risk factors associated with hypertension in Yi ethnic group aged 50 years and over in rural China:the Yunnan minority eye study[J].BMC Public Health,2015,15:383.
[12] 陈邕,王嘉凌,陈庆宪.2002-2004年西南地区62家医院抗高血压药利用分析[J].中国药房,2005,16(22):1718-1720.
[13] 聂静雨,张林峰,陈祚,等.社区人群中高血压患者的用药情况分析[J].中华高血压杂志,2017,25(10):956-960.
[14] Lu J,Xuan S,Downing NS,et al.Protocol for the China PEACE (patient-centered evaluative assessment of cardiac events) million persons project pilot[J].BMJ Open,2016,6(1):e010200.
[15] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[16] James PA,Oparil S,Carter BL,et al.2014 evidence-based guideline for the management of high blood pressure in adults:Report from the panel members appointed to the eighth joint national committee (JNC8)[J].JAMA,2014,311(5):507-520.
[17] 国务院人口普查办公室,国家统计局人口和就业统计司.中国2010年人口普查资料[DB/OL].2018-09-12.http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm.
[18] 王卓群,杨静,赵艳芳.2010年中国西部地区成人高血压流行现状分析[J].中国预防医学杂志,2014,15(3):241-244.
[19] Li D,Lv J,Liu F,et al.Hypertension burden and control in mainland China:analysis of nationwide data 2003-2012[J].Int J Cardiol,2015,184:637-644.
[20] 李镒冲.我国高血压患病、知晓、治疗和控制的多水平空间分析[D].中国疾病预防控制中心,2016.
[21] Wang W,Jiang B,Sun H,et al.Prevalence,incidence,and mortality of stroke in China:results from a nationwide population-based survey of 480 687 adults[J].Circulation,2017,135(8):759-771.
[22] Ma WJ,Tang JL,Zhang YH,et al.Hypertension prevalence,awareness,treatment,control,and associated factors in adults in southern China[J].Am J Hypertens,2012,25(5):590-596.
[23] Yang L,Yan J,Tang X,et al.Prevalence,awareness,treatment,control and risk factors associated with hypertension among adults in Southern China,2013[J].PLoS One,2016,11(1):e0146181.
[24] Le C,Jun D,Yichun L,et al.Multilevel analysis of the determinants of pre-hypertension and hypertension in rural southwest China[J].Public Health Rep,2011,126(3):420-427.
[25] Wang JG,Li Y.Characteristics of hypertension in Chinese and their relevance for the choice of antihypertensive drugs[J].Diabetes Metab Res Rev,2012,28 Suppl 2:67-72.
[26] European Society of Cardiology (ESC),European Society of Hypertension (ESH).First look at the new 2018 European guidelines for the treatment of high blood pressure[DB/OL].[2018-06-09].http://www.eshonline.org/esh-annual-meeting/.
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