| Hypertension is a kind of cardiovascular syndrome, which mainly manifests high blood pressure in clinic and is the major risk factor of cardio-cerebrovascular disease in China. Currently, there are about230milloin cardiovascular patients in our country, and including200million hypertension patients. The large increase in the number of patients with hypertension is a mass phenomenon, thus interventions which are targeted to take the overall population into account, can effectively enhance awareness rate, treatment rate and control rate of hypertension. Currently, there has been a steady push for the idea of community-based prevention and control of hypertension all over the country. Hypertension has been listed as one of four managed chronic diseases by community-based management of chronic diseases. Implementation of community interventions plays a key role for patients with hypertensive disease. Meanwhile, as people have realized that hypertension is a kind of lifestyle disease, interventions need to be established according to its major risk factors. Only improving people’s adverse lifestyles can we fundamentally prevent and control the development of hypertension. Because if its advantages of convenience, economy and easy manipulation, traditional Chinese medicine is more suitable to extensively implemented in prevention and cure of hypertension in the community.Objective1. To review the related literatures on influence factors, evaluation indicator, community management and life quality of hypertension, and take this as theoretical foundation to study community intervention of hypertension by traditional Chinese medicine and assess life quality.2. This research adopts cohort study to investigate the effects of non-drug therapy of traditional Chinese medicine on antihypertensive efficacy and improvement of life quality in patients with essential hypertension.MethodWe used a community based cohort study of patients with essential hypertension who received treatment in selected community between March2012and April2013. Patients were enrolled from the selected community. Essential hypertension can be divided into two types as hypertension with liver-Yang ascending syndrome and with dual vacuity of the heart and liver syndrome (type of disharmony of Chong and Ren included) according to TCM syndrome differentiation. Both groups received basic interventions of non-drug therapy for hypertension by means of public awareness and education; the TCM group also received traditional Chinese medicine interventions of non-drug therapy for hypertension, including:meals based on syndrome differentiation (guided by TCM), application of Qiduantongtiao Jiangya Gong based on differentiation of symptoms, treatment based on differentiation of symptoms (self-therapeutic massage on acupoints). The duration of interventions was1year. Follow-ups were carried out at3、6、9and12months after the beginning of intervention. Changes of blood pressure were recorded before and each time point of follow-up after interventions. SF-36scale, TCM-SCL-36questionnaires were studied in TCM group before and after interventions; SF-36scale, TCM-SCL-36questionnaires, participants’ acquirement of knowledge and treatment compliance were evaluated and recorded in both groups at12months after interventions. Statistical methods:Data were analyzed using the statistical software of SPSS statistics17.0. If variables were normally distributed, measurement data were analyzed using t-test, comparison of two sample means was analyzed using independent-samples t-test, and measurement data of matched pair design were analyzed using t-test of paired samples; if some variables were non-normally distributed, measurement data were analyzed using non parametric test, measurement data of matched pair design were analyzed using Wilcoxon signed-rank test, and grouped data were analyzed by χ2test. Impact factors were analyzed by multivariate analysis of covariance. Significance was declared for p values<0.05.Result98cases were collected in the TCM group, and100in the control group.1. Control of blood pressure (1)12months after intervention, contractive pressure reduced by (9.93±11.63) mmHg in TCM group,(4.06±9.42) mmHg in control group, contractive pressure decrease between two groups has statistical significance (P=0.00); diastolic pressure reduced by (9.23±9.09) mmHg in TCM group,(2.33±8.20) mmHg in control group, there was statistical significance between two groups on diastolic pressure reduction (P<0.00).(2) At the end of12months’ intervention, control rate of hypertension enhanced32.65%in TCM group and18.00%in control group. Blood pressure can be classified to three levels as normal blood pressure, high-normal blood pressure and hypertension. The proportion of the three levels was respectively1.02%,50.00%and48.98%before intervention and15.31%,79.59%and5.10%at12months after intervention in TCM group;0.00%,39.00%and61.00%before intervention and2.00%,57.00%and41.00%at12months after intervention in control group.(3)12months after intervention,3patients in TCM group stopped taking antihypertensive drugs according to prescription; but there was no significant change in having antihypertensive drugs in control group. Both groups had no cardiovascular events during one-year intervention.2. Compliance investigation(1) The average score was (18.84±2.02) in TCM group and (16.15±3.18) in control group during basic interventions. Score in TCM group was higher than control group, and the difference was statistically significant (P<0.00).(2) The distribution of score in TCM group during TCM interventions were: compliance of more than50%of the patients was good (3points),20～40%was moderate (2points) and less than10%was poor (1points).3. Assessment of life quality(1) SF-36scale:comparison of TCM group before and after intervention, scores increased in the dimension of physical functioning.(2) TCM-SCL-36questionnaires:comparison of TCM group before and after intervention, scores increased in all of the dimensions. Conclusion1.5randomly blood pressure changes before and after intervention, the increase of control rate of blood pressure, the changes of blood pressure control states and the changes of medication all demonstrated that the community non-drug therapy of traditional Chinese medicine can significantly decrease the contractive and diastolic pressure of the patient, lower the use of antihypertensive agent to some extent and effectively enhance the control rate of hypertension.2. Score of participants’ acquirement of knowledge and compliance investigation questionnaires:patients with hypertension in community had good compliance of non-drug therapy of traditional Chinese medicine, and participation in intervention of non-drug therapy of traditional Chinese medicine can enhance their awareness and activeness of prevention and control of hypertension, therefore raise the compliance of basic intervention of western medicine.3. Assessment of life quality:(1) The results of SF-36scale demonstrated that comprehensive intervention can improve patients’ physical functioning, and positive effects on life quality of the patients.(2) The results of TCM-SCL-36questionnaires showed that comprehensive intervention had some positive effects on heart, spleen, lung, kidney and comprehensive satisfactions. |
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