Effectiveness of intensive hypertension management model for patients with uncontrolled blood pressure in community
10.3760/cma.j.issn.1671-7368.2019.04.007
- VernacularTitle:社区强化管理达标模式在高血压未控制患者中的应用效果分析
- Author:
Shuping ZHENG
1
;
Jinbao JI
;
Xin CHEN
;
Junli ZUO
;
Shaoli CHU
Author Information
1. 上海市嘉定区江桥社区卫生服务中心 201804
- Keywords:
Hypertension;
Disease management;
Community health service;
General practitioner
- From:
Chinese Journal of General Practitioners
2019;18(4):328-332
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effect of intensive hypertension management model for patients with uncontrolled blood pressure in community.Methods Three hundred and seven hypertensive patients,whose blood pressure was not controlled with administration of two or more kinds of antihypertensive drugs,entered in the intensive management program from May 2015 to December 2017.Using calcium channel blockers,angiotensin converting enzyme inhibitors or angiotensin receptor blockers and diuretic as the primary scheme,the medication was adjusted by general practitioners under the guidance of specialists in tertiary hospitals.The "seamless" two-way referral between community and tertiary hospitals was implemented,and the blood pressure control,medication and adverse effects were analyzed.Results Among 307 patients,157 were males (51.1％) and the mean age was (65.0±8.6) years.There were 246 (80.0％)patients with moderate and severe hypertension 44 (14.3％) patients complicated with diabetes,and 63(20.5％) patients having comorbidities,and the patients with high risk or extremely high-risk accounted for 85.0％ (261/307).Through (3.97± 1.21) months (1-6 months) intensive management,systolic blood pressure decreased from (167.56±16.73)mmHg(1 mmHg=0.133 kPa) in the baseline to (132.79±11.24)mmHg (t=33.34,P＜0.01),and diastolic blood pressure from (95.34± 12.59) mmHg to(79.11 ±7.85) mmHg (t=23.67,P＜0.01),blood pressure control rate was 75.6％(232/307).No serious adverse reactions occurred.During the period 42 patients were referral to hospital through green channel with a referral rate of 13.7％,and six patients were diagnosed as secondary hypertension.Angiotensin receptor antagonists and calcium antagonists were the main antihypertensive drugs.After intensive management patients taking three or more antihypertensive drugs increased by 158 and those taking diuretics increased by 116.Conclusions The intensive management model is effective in patients with uncontrolled blood pressure in community.Early use of C+A,A+D,and A+C+D treatment schemes for uncontrolled patients in the community can improve the rate of reaching the target and is safe.
