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目的了解强化干预是否可以降低社区高血压伴糖代谢异常人群血压和心脑血管事件。方法采用随机整群抽样方法抽取南宁市两个社区的1215人为研究对象,随机分成强化干预组和对照组。强化干预组按照是否患有高血压及其相关疾病分别采取不同的强化治疗方案进行干预;对照组人员维持志愿就诊和志愿服药的正常医疗状态,随访43.5个月,记录发生心脑血管事件情况。结果(1)两组高血压和糖代谢异常患者收缩压和舒张压较干预前明显降低(P<0.01)。(2)两组高血压伴糖代谢异常者收缩压和舒张压分别降低11.47、7.58和5.23、5.28mmHg,而高血压伴血糖正常者干预后分别降低16.78、10.38和9.6、6.02mmHg(P<0.01)。(3)本组心脑血管事件发生率为4.0%,事件发生率高血压、糖代谢异常患者明显高于非高血压和血糖正常者(P<0.01),其中对照组均明显高于相应的干预组(P<0.01)。(4)高血压伴糖代谢异常者事件发生率为8.4%,明显高于高血压伴血糖正常者(P<0.01)。高血压伴糖代谢异常干预组发生心脑血管事件的相对风险较对照组降低3.83倍。结论综合强化干预可明显降低社区高血压伴糖代谢异常人群血压水平,降低心脑血管事件发病风险。
Objective To investigate whether intensive intervention can reduce blood pressure and cardiovascular events in community-based hypertensive patients with abnormal glucose metabolism. Methods A total of 1215 people from two communities in Nanning City were randomly divided into intensive intervention group and control group by random cluster sampling method. Intensive intervention group according to whether they have hypertension and its related diseases, respectively, to take different intensive treatment intervention; control group of volunteers to maintain voluntary medical care and maintenance of normal medical conditions, followed up for 43.5 months, recorded cardiovascular and cerebrovascular events. Results (1) The systolic and diastolic blood pressures in patients with abnormal blood pressure and glucose metabolism were significantly lower than those before intervention (P <0.01). (2) Systolic blood pressure and diastolic blood pressure were decreased by 11.47, 7.58 and 5.23,5.28mmHg in both groups with abnormal glucose metabolism, but decreased by 16.78,10.38 and 9.6,6.02mmHg in hypertensive patients with normal blood glucose (P < 0.01). (3) The incidence of cardiovascular and cerebrovascular events in this group was 4.0%, the incidence of hypertension and glucose metabolism was significantly higher in patients with non-hypertension and normal blood glucose (P <0.01), in which the control group were significantly higher than the corresponding Intervention group (P <0.01). (4) The incidence of hypertension with abnormal glucose metabolism was 8.4%, which was significantly higher than those with hypertension and normal blood glucose (P <0.01). Compared with the control group, the relative risk of cardiovascular and cerebrovascular events in hypertension intervention group was 3.83 times lower than that in control group. Conclusion Comprehensive and intensive intervention can significantly reduce the blood pressure of community hypertension patients with abnormal glucose metabolism and reduce the risk of cardiovascular and cerebrovascular events.