| Objective:To observe the regularities of distribution of traditional Chinese medicine (TCM) syndrome types and the relationships between TCM syndrome types and levels of cardiovascular prognosis risk factors of elderly hypertensive patients in three different communities of city and county (Huichen elderly community of Beijing, Hongshan community of Wuhan and Fuzhu rural community of Xishui County, Huanggang City). To evaluate the therapeutic effects of elderly fluctuant hypertension interventional service package on decreasing the blood pressure variability of elderly hypertensive patients in Huichen elder community of Beijing.Methods:By cross-sectional investigation, We screened 299 elderly hypertensive patients who conforms to the hypertensive diagnostic criteria from 896 respondents which participated in the health monitoring questionnaire drafted by health management team of China Academy of Chinese Medical Sciences. the demographics, the HPI, the Four Diagnosis information of TCM, diet & exercise were recorded, and the levels of some indictors, such as ET, Hcy, mALB, blood lipid, blood glucose were measured by radioimmunoassay, enzymatic cycling assay and other methods, and to summarized the distribution regularity of TCM syndromes of 299 elderly hypertensive patients by factor analysis based on their sings and symptoms.The syndrome types of 299 elderly hypertensive patients were differentiated according to Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine (for Trial Implementation) and TCM gerontology. To analysis the relationships between TCM syndrome types and levels of cardiovascular prognosis risk factors of elderly hypertensive patients.We designed the community elderly fluctuant hypertension interventional service package by Literature research and evidence of evidence-based medicine, and to observe the community elderly fluctuant hypertension interventional service package on 46 elderly fluctuant hypertensive patients (stagnation of phlegm-dampness type and blood stasis type)in Huichen elderly community of Beijing through Prospective, nonrandomized self-control study.Results:① Of all the 299 cases in the three communities, the ages of elderly patients in Huichen elderly community of Beijing are higher than others, and 66.5 percent of them have 11 to 20 years course of disease. The very high risk stratification consists most of the risk stratification structure, which is accounting for 58.3% and has an ideal treatment compliance. And all of the patients have a good blood pressure control, but with a wide pulse pressure. Most of elderly patients in Hongshan community of Wuhan and Fuzhu rural community of Xishui County, Huanggang City have 0 to 5 years course of disease, accounting for 93.88%,86.5%perspectively; The high risk stratification consists most of the risk stratification structure, accounting for 50.3%,56.7% perspectively with a nonideal treatment compliance.② Of all the 299 elderly hypertensive patients can be divided into 5 types.5 TCM syndrome types of 299 elderly hypertensive patients were in sequence of deficiency of yin and yang type (74cases)>hyperactivity of yang due to yin deficiency type (65cases)>blood stasis syndrome type(62 cases)>stagnation of phlegm-dampness type(61cases)>hyperactivity of liver-yang type(37cases). And the 5 TCM syndromes have relationship with patients’age, course of disease, blood pressure levels and risk stratification structure. With the risk factors get worse, the hyperactive elderly hypertension’s TCM syndromes made most of blood stasis syndrome type and stagnation of phlegm-dampness type can transform into the hyperactive with deficiency syndrome(the deficiency is more part of it) made of deficiency of yin and yang type and hyperactivity of yang due to yin deficiency type.③ It shows that the differentiations of BMI、FCG、GHbAlc、CREA、TC、 LDL-C、ET、Hcy and mALB in the 5 TCM syndromes of all the 299 elderly hypertensive patients have statistical significance(P<0.05or P<0.01) in three communities by single factor analysis, and the differentiation is more apparent in the hyperactivity of yang due to yin deficiency type, stagnation of phlegm-dampness typeand blood stasis syndrome type. Discriminant analysis shows that the levels of BMI and Hcy have reference value for the 5TCM syndromes. binary-Logistic regression analysis shows that the course of disease has a positive correlation with the deficiency of yin and yang. It shows that the differentiations of BMI、DBP、PP、FPG、TC、TG、LDL-C、ET、Hcy and mALB in the 5 TCM syndromes of the 108 elderly hypertensive patients have statistical significance (P<0.05orP<0.01) in Huichen elderly community of Beijing by single factor analysis, and the differentiation is more apparent in deficiency of yin and yang type, the stagnation of phlegm-dampness typeand blood stasis syndrome type. binary-Logistic regression analysis shows that the age and course of disease has a positive correlation with the deficiency of yin and yang. the risk stratification structure has positive correlation with blood stasis syndrome type.④ To observe the community elderly fluctuant hypertension interventional service package on 46 elderly fluctuant hypertensive patients(stagnation of phlegm-dampness type and blood sta-sis type)in Huichen elderly community of Beijing through Prospective, nonrandomized Self-control study shows that the levels of SBPM、nDBP-SD、nSBP-CV、nDB-CV became much lower after treatment in the blood stasis syndrome type(P<0.05), The levels of dDBP、 SBPM、24hDBP-SD、dDBP-SD and nDBP-SD had a certain degree of improvement in the stagnation of phlegm-dampness type (P<0.05). The treatment also have developed physical symptoms of patients on the blood stasis syndrome type and sleep of patients on the stagnation of phlegm-dampness type.Conclusion:The TCM syndrome types of elderly hypertensive patients were, in order, yin and yang type, hyperactivity of yang due to yin deficiency type, blood stasis type, stagnation of phlegm-dampness type and hyperactivity of liver-yang type. blood stasis type and stagnation of phlegm-dampness type are more closely related to hypertension cardiovascular prognosis risk factors, and it is more likely to occur stroke, myocardial infarction and other cardiovascular events than other types of elderly hypertensive patients. and the age, course of disease, blood pressure levels and risk stratification of elderly hypertensive patients have an effect on the regularities of distribution of traditional Chinese medicine (TCM) syndrome types. To observe the community elderly fluctuant hypertension interventional service package on 46 elderly fluctuant hypertensive patients (stagnation of phlegm-dampness type and blood stasis type) in Huichen elder community of Beijing through Prospective, nonrandomized Self-control study. The community elderly fluctuant hypertension intervetional service package, including health education, exercise therapy, medication treatment(Ch-inese herbal medicine) and blood pressure monitoring, based on cooperation among patients, community social worker and Physician, is useful to decrease blood pressure variability on 46 elderly fluctuant hypertensive patients (stagnation of phlegm-dampness type and blood stasis type)to some extent in Huichen elderly community of Beijing. |
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