The Study On The Effect Of "Co-management Of Doctors Of Three Kinds" In Zhonghua Health Service Center Of Xiamen

Objectives In this study,we investigated the change of cholesterol,fasting glucose,the changes of blood pressure in different seasons and the control rate blood pressure before and after adding the "co-management of doctors of three kinds" project in patients with hypertension in Zhonghua street health service center of Xiamen,also we analyzed the effectiveness of the primary prevention of cardiovascular and cerebrovascular diseases.And we further explored the relationship between systolic blood pressure(SBP),Cardiovascular Health Score(CHS)and visit-to-visit blood pressure variability(BPV).Also we analyzed the changes of blood pressure variability in different follow-up periods.Methods This study was a prospective cohort study of 727 cases of hypertension patients who voluntarily join the “co-management of doctors of three kinds” in Zhonghua street health service center of Xiamen from April 2015 to July 2015.A total of 587 individuals who met the inclusion criteria(enough information available and no history of stroke,transient ischaemic attack,myocardial infarction,malignant tumour)were enrolled in this study.Physical examination,monthly hypertension health education network and follow-up blood pressure were implemented each patient who join the "co-management of doctors of three kinds" project in an outpatient clinic.All patients were followed up for 18 times in a total of 1.5 years.The changes of blood pressure compliance rate before and after treatment were observed.Compared the mean systolic pressure among summer and winter in 2015,and summer in 2016,and the changes of cholesterol treatment rate and antiplatelet treatment rate before and after treatment were compared.A total of 444 patients were followed up for a period of up to one year,and all of them accepted the physical examination for two times.The changes of cholesterol compliance rate and fasting blood glucose compliance rate in all 444 cases were compared.According to the American Heart Association proposed the Cardiovascular Health Score(CHS),patients were divided into five groups according to different levels of SBP.Multivariable linear regression models(stepwise method)was used to analyze the related risk factors which might affect BPV and SCV.SPSS17.0 statistical software was utilised for statistical analysis.Intergroup comparisons were performed by t test.The rate of comparisons were performed by chi square test.The criterion for significance is set at P < 0.05 based on two sides.Results(1)There are 587 participants in the study,308 were male,279 were female,and the baseline age was(67.52±10.62)years old.389 of them are obesity,360 with high cholesterol,and 245 people with diabetes mellitus.(2)Among the 444 participants,cholesterol compliance rate was 38.06% before joining the management.One year later,the cholesterol compliance rate increased to 45.72%,and the difference was statistically significant(p=0.006).The fasting glucose was(7.18±2.22)mmol/L before the management,and changed to(7.21±2.57)mmol/L one year later.There was no statistical difference in fasting glucose(p=0.932).In all patients,486 patients met the standard of lipid-modifying therapy,288 participants had taken lipid-regulating drugs after adding this management,significantly higher than those before the management(p=0.002).There were 545 patients who were treated by antithrombotic therapy,233 participants was antithrombotic users after adding management,obviously higher than those before the management(201)(p=0.048).(4)Among the 587 participants,before the management,47.53% of the patients were treated with single antihypertensive therapy,and 52.30% of the patients were treated with combination antihypertensive;after one year's management,the data changed into 40.89% and 58.94%.The difference was statistically significant(p=0.022).(5)The baseline systolic blood pressure was(142.61 + 16.95)mm Hg before the management,and blood pressure control rate was 42.76%;after 1.5 years of follow-up,the systolic blood pressure reach to(134.39 + 10.73)mm Hg,and the blood pressure control rate increased to 70.02%.The blood pressure control rate was significantly higher than before(p<0.001).(6)In 2015,the average systolic pressure in winter was higher than that in summer(p=0.020),and it was higher than that in summer of 2016(p<0.001).The average systolic pressure in summer 2016 was lower than that in summer 2015(p=0.002).(7)Linear regression analysis demonstrated that SBP,gender,CHS were risk factors of BPV and CV.Every twenty mm Hg increase of SBP was linked with 1.614 mm Hg increase of BPV and 0.573% increase of CV.Each SD increase in CHS could lead to a 0.234 mm Hg decrease in BPV and 0.161% decrease in CV.(8)During the 17 times? follow-up,with the initial network management of blood pressure,BPV of the first 9 months is(8.25 + 3.78)mm Hg,and the second 9 months is(7.43 + 3.12)mm Hg.The second BPV is smaller than the first one(p<0.001).Our study confirmed that long-term management may contribute to the stability of blood pressure.Conclusion The implementation of the "co-management of doctors of three kinds" of hypertension in Xiamen is helpful to improve the cholesterol,blood pressure control and the primary prevention of cardiovascular and cerebrovascular diseases in hypertensive patients.In winter,the average systolic pressure was higher than summer,and the average systolic pressure of the same season was lower than earlier management one.Baseline SBP,CHS and gender are important factors affecting BPV and CV in elderly people.Higher SBP is closely related to larger BPV in this cohort.The long-term management of the "co-management of doctors of three kinds" of hypertension is helpful to the stability of blood pressure in patients with hypertension.