The Effect Evaluation Of Community-based Hypertension Management In Jangsu

Objectives:To evaluate the effect of community-based standardized hypertension management and explore the factors of control rate of hypertension in Jiangsu province, providing a basis for the policy and strategy of hypertension management.Methods:The community-based control trial design was applied to investigate the hypertensive patients managed by38primary health care centers in Jiangsu province from2011-2012. Participants were enrolled according to the study protocol and the enrollment and exclusion criteria. All participants were divided into two groups. One was a standardized hypertension management group, managed by hypertension grading management. The other was a conventional management group, treated by conventional management. Epidermiology investigation was conducted to collect the participants’characteristics, disease history, lifestyle and medication fee information. All participants were taken the physical and experimental examinations. The control rate of hypertension and the effectiveness of intervention were evaluated after1-year management. The economic burden of hypertension was also analyzed. T-test and chi-square test were used in univariate analysis. Multi-variable analysis and Logistic regression model were applied to explore the effectiveness of hypertension management, the burden of hypertension and the influence factors. The ecomomic assessment of managenment applied cost-effect analysis, using the cost-effect ratio to measure it.Results:A total of10,977hypertensive patients with full-qualified information were managed for1year. The efficacies of intervention for smoking, drinking and systolic/diastolic blood pressure were at-9.2%,-7.6%and (-15.1/-9.8) mmHg respectively after1-year period, which were higher than those of control group significantly. The rate of major adverse cardiovascular and cerebrovascular events (MACCE) was0.4%in the experimental group, lower than that of control group. Over1-year standardized management, the control rate of hypertension was64.0%in the experimental group, higher than that of control group. The blood pressure in the experimental group indicated a gradual downward trend during the follow-up period.There were8,424participants with qualified economic investigation information included in cost-effectiveness analysis. In quantity, the cost-effectiveness ratio (cost per1mmHg reduced blood pressure) in control group was lower than that of experimental group. However, the cost per1%increased control rate, a relative rate for blood pressure control, in experimental group was lower than that of control group.The result of logistic regression analysis showed that age, gender, educational level, the grading of baseline blood pressure and the hypertension family history were influence factors for the control rate of hypertension. In addition, multi-variable regression analysis indicated that in-hospital, risk classification, the grading of baseline blood pressure, the type of medical insurance and days of in-hospital were the influence factors for direct medical cost.Conclusions:①The standardized management to hypertensive patients in community was beneficial for reducing the smoking rate and alcohol drinking rate significantly, as well as controlling the salt intake in population obviously. While the changes in body mass index (BMI) and dietary fat of the population were limited.②The standardized management to hypertensive patients in community could indeed lower the blood pressure level and improve the control rate of hypertension. It also prevented the occurrence of MACCE. In the experimental group, the average blood pressure of all patients showed a gradual downward trend during the follow-up period.③The beneficial factors for hypertension control included the elder age, high education level and the intervention management. However, the male, overweight/obesity, the higher grading of baseline blood pressure and the hypertension family history were risk factors for hypertension control.④The results of cost-effectiveness analysis showed the cost for hypertension control in experimental group, compared with the control group, was much lower. With a good cost-effectiveness ratio, the standardized management to hypertensive patients in community indicated an economic significance in community-based hypertension management.This study testified that community-based standardized hypertension management could reduce blood pressure and prevent the occurrence of MACCE in hypertensive patients effectively. The control rate was improved with an economic significance. So, this mode of hypertension management can be further popularized at community level in China.