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目的了解强化干预对社区中老年高血压或伴有脂代谢异常人群心血管事件(CVD)的影响。方法采用整群抽样南宁市两个社区的1215人为研究对象,随机分成强化干预组和对照组。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CVD发生情况。结果随访43.5个月后,单纯高血压患者及高血压伴血脂异常患者干预组和对照组收缩压和舒张压均较干预前明显降低(P<0.01);两组CVD合计43例(4.0%),患有高血压者明显高于非高血压患者(6.9%vs2.9%,χ2=9.004,P=0.003,OR值2.492,95%CI 1.349-4.601);(3)干预组无论高血压或非高血压者CVD均明显低于对照组(其中2χ=4.729和6.822,和P=0.03和0.009,OR值2.645和3.438,95%CI为1.006-6.562和1.296-9.118)。结论高血压是社区中老年人CVD的高危因素,强化干预或普通干预均可明显降低社区高血压患者及伴有脂代谢异常人群血压水平。强化干预改变多重风险因子的作用较非强化干预能够更多的减少社区中老年人CVD的发生。
Objective To investigate the effect of intensive intervention on cardiovascular events (CVD) in elderly with hypertension or with lipid metabolism in community. Methods A total of 1215 people from two communities in Nanning City were enrolled in this study. They were randomly divided into intensive intervention group and control group. Intervention groups were treated with different intensive treatment regimens according to whether they had high blood pressure and their related diseases respectively. The control group patients were followed up for 43.5 months with the normal medical conditions of volunteer treatment and volunteer medication, and the incidence of CVD was recorded. Results After 43.5 months of follow-up, the systolic and diastolic blood pressures in the patients with hypertension and those with dyslipidemia were significantly lower than those before intervention (P <0.01) (6.92% vs2.9%, χ2 = 9.004, P = 0.003, OR = 2.492, 95% CI 1.349-4.601); (3) The patients in the intervention group had no significant difference in hypertension or CVD in non-hypertensive patients were significantly lower than that in the control group (2χ = 4.729 and 6.822, P = 0.03 and 0.009, OR = 2.645 and 3.438, 95% CI 1.006-6.562 and 1.296-9.118 respectively). Conclusion Hypertension is a risk factor for CVD in the elderly in community. Intensive intervention or general intervention can significantly reduce blood pressure in community-based hypertensive patients and those with abnormal lipid metabolism. Intensive intervention to change the role of multiple risk factors than non-intensive interventions can reduce the incidence of CVD in the community more.