陈伟伟
国家心血管病中心，阜外医院
BACKGROUND:It is not fully clear whether the effect of short-term management in community can reduce the long-term risk of stroke OBJECTIVES:: To evaluate whether short-term hypertension management is associated with long-term incidence of stroke and total death in community health centers in China.DESIGN:Community controlled trail.PARTICIPANTS:Six community health centers (4 active, 2 control) in China, patients with hypertension.CONTROL ARM:Patients were treated with normally therapy method.ACTIVE ARM:Patients were treated oriented by the Guideline for hypertension management.RANDOMIZATION:Two centers (Hebei and Zhejiang) from the Hypertension Control in Community (HCC) Project, which was conducted from 2005 to 2008, were randomly selected for this study. Four thousand hypertensive patients from these centers, who were under management for one year in the baseline, were followed up in 2013. The electronic health record system (2005-2008) was used to identify 2000 hypertensive patients, who were not included in HCC but lived in comparable community health center in the same province, as the control group. All baseline and follow-up data were collected using standardized questionnaires for stroke outcomes.MAIN OUTCOME MEASURES:Stroke.RESULTS:Of the 6000 participants, 3787 (63.1%) were eligible for analysis. At the time of follow-up, the average BP was kept in the lower level than that in baseline, and the control rate was 59.3%. After propensity-score matching, 110 strokes (2.0% vs 4.6%) and 141 deaths (1.4% vs 3.8%) were noted in the matched intervention and control groups (1078 pairs), respectively. Patients in the intervention group were less likely to experience a stroke or die than those in the control group (hazard ratio [HR] = 0.40, 95% confidence interval [CI]: 0.26-0.62, P < 0.01; HR = 0.50, 95% CI: 0.35-0.72, P < 0.01). The sensitivity analysis showed similar results.CONCLUSIONS:Short-term management of hypertension had a positive effect on the long-term risk reduction of death and stroke in hypertensive patients.
Medicine 2016
BACKGROUND:Blood pressure (BP) control in China is generally poor. It is assumed that an important cause of this unsatisfactory situation is the present standard of care provided by primary care physicians.METHODS:One thousand community health centers (CHCs) were selected across China based on geographical location, previous cooperative experience, and acceptance of an invitation to implement a standardized protocol of community-based BP management. Baseline information for each hypertensive patient under the care of these CHCs was collected, and the present pattern of hypertensive drug treatment was analyzed.RESULTS:Of all identified hypertensive patients (n = 249,830), 37% were treated with drugs. Characteristics linked with hypertension treatment included systolic BP, age, sex, region, smoking and alcohol consumption status, body mass index, comorbidities, and family history. The most frequently prescribed classes of antihypertensive drugs were diuretics (56.0%), followed by centrally active drugs (CADs) (38.3%), calcium channel blockers (CCBs) (36.8%), vasodilators (26.5%), and angiotensin-converting enzyme inhibitors (ACEIs) (23.3%). In regards to drug combination patterns, diuretics plus CADs was the most frequently used 2-drug combination (61.4%) and vasodilators plus CADs plus diuretics was the most frequently used 3-drug therapy (69.2%). Seventy-seven percent of patients on combination therapy were prescribed single pill combinations, 87.2% of which were composed of CADs and vasodilators and 12.8% of which were composed of ACEIs and diuretics. The control rates of patients on monotherapy and combination therapy were 27.7% and 24.1% (P < 0.05), respectively.CONCLUSIONS:Our study identified major shortcomings in the present status of antihypertensive pharmacotherapy in routine medical practice in China. It is essential to implement a program of professional education regarding the appropriate use of antihypertensive drugs.
American journal of hypertension 2014
OBJECTIVE:To understand the situation of blood pressure control and the major factors influencing the programs among those hypertensive patients living in the communities from different parts of China.METHODS:A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained under the requirement of this protocol to manage the hypertensive patients. In this study, the hypertensive patients who had been registered in the project centers from Beijing, Hebei, Gansu, Jiangsu, Zhejiang, Guangdong provinces, were selected as the study subjects, and the baseline data for these patients was analyzed.RESULTS:By the end of 2010, a total of 242 182 patients were registered. The mean age was 61.0 ± 10.5, with 48.5% of them being males. The overall control rate of blood pressure was 27.4%. The control rate was significant lower among patients who were in lower age group, being male, with higher BMI, smoking, drinking or with more salt consumption. However, the control rate was significant higher among those patients who had family history of hypertension, always undertook physical exercise or receiving medical treatment.CONCLUSION:The blood pressure control rate for community hypertensive patients in China was still in a relatively low level. Standardization management measures should be strengthened so as to improve the rate of control on high blood pressure.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 2012
Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.
Biomedical and environmental sciences : BES 2012
