Evaluation Of Individualized Therapeutic Effect Of Community Intervention For Patients With Hypertension And Diabetes Based On BART

In recent decades,the morbidity and prevalence of hypertension and diabetes have shown an upward trend.Both of them are the main risk factors for the morbidity and mortality of cardiovascular diseases such as stroke and coronary heart disease.However,the awareness rates,treatment rates and control rates of these diseases were at a low level.In reality,hypertension and diabetes often coexist.When hypertension and diabetes coexist,they have synergistic effects on the cardiovascular system.There are many ways to intervene and treat hypertension and diabetes,However,the increase of the prevalence of hypertension and diabetes mellitus have not been curbed.Therefore,it is necessary to comprehensively evaluate the effect of community intervention in the real world,and to determine whether to adopt some intervention measures among people with some characteristics through individualized efficacy evaluation,so as to achieve the purpose of promoting group health.In this study,people with hypertension and diabetes mellitus in the project of Comprehensive Prevention and Treatment of Hypertension and Diabetes Mellitus in the Whole Population of Jiaonan were taken as the research objects.The control rate,exercise rate and obesity rate in the management process were evaluated.The BART method was used to explore the individualized efficacy evaluation of prescriptions and to identify subgroups with high therapeutic effect.Finally,logistic regression was used to analyze the influencing factors of medication compliance.The results are as follows:1.In a cohort of 9496 patients with hypertension and diabetes mellitus,59.61%of them received no less than two follow-up visits to hypertension management,and 59.22%received no less than two follow-up visits to diabetes management.Among them,3575 people(37.65%)received both hypertension management and diabetes management,and the follow-up times of both diseases were 2 or more.2.In the management of hypertension,the control rate of hypertension in the standard and non-standard groups increased with time being managed.The exercise rate of both groups increased with time being managed,and that of the standard group was higher.There was no significant difference in obesity rates between the two groups.The control rate of hypertension in regular medication group was always higher than that in discontinuous medication group and non-taken medication group.The control rate of the three groups increased with time being managed.3.The most frequently used prescription types for hypertension management was"not use drug".Other types with more frequent used include captopril,nitrendipine,"nitrendipine + captopril".4.After propensity score matching,the control rate of hypertension in captopril group was higher than that in non-taken medication group.In individualized efficacy evaluation,captopril alone was better in 81.72%of patients.Captopril alone was more effective for those with low SBP,no overweight or obesity,and frequent exercise.5.After propensity score matching,the control rate of hypertension in"nitrendipine + captopril" group was higher than that in non-drug group.In individualized efficacy evaluation,"nitrendipine + captopril"was better for all."Nitrendipine + captopril" was more effective for patients with lower SBP and good exercise habits.6.After propensity score matching,the control rate of hypertension in"nitrendipine + captopril" group was higher than that in captopril group alone.In individualized efficacy evaluation,99.63%of the patients used "nitrendipine +captopril " had better effect." Nitrendipine + captopril" was more effective for patients with coronary heart disease and taking antiplatelet drugs.7.In the diabetes management of patients,the control rate of diabetes in the standard group increased steadily with time being managed,while that in the non-standard group increased first,then decreased,and finally was lower than that in the standard group.The exercise rate of both groups increased with time being managed,and that of the standard group was higher.There was no significant difference in obesity rates between the two groups.The control rate of diabetes mellitus in regular medication group and discontinuous medication group increased with time being managed,but there was no significant difference between the two groups.The control rate of diabetes mellitus in non-taken medication group was always higher than that in other two groups,but the control rate fluctuated greatly,showing unstable characteristics.8.The most frequently used prescription types for diabetes management was also"not use drug".Other types with more frequent used included metformin,"metformin+ glipizide" and glipizide.9.After propensity score matching,the control rates of diabetes mellitus in metformin group and non-metformin group were similar.In individualized efficacy evaluation,72.53%metformin alone was better.Metformin alone had better therapeutic effect on patients with lower DBP and frequent exercise.10.After propensity score matching,the control rate of diabetes in the "metformin+ glipizide" group was lower than that in the non-drug group.In individualized efficacy evaluation,46.15%of patients treated with "metformin + glipizide" had better therapeutic effect."Metformin + glipizide" was more effective for women who are not obese.11.After propensity score matching,the control rate of diabetes in "metformin +glipizide" group was lower than that in metformin group alone.In the individualized efficacy evaluation,metformin alone was better for all patients.Metformin alone was more effective in patients with lower DBP and frequent exercise.12.The influencing factors of medication compliance of hypertension included BMI,gender,labor intensity,exercise,stroke and coronary heart disease;the influencing factors of medication compliance of diabetes included age,FBG,gender and alcohol consumption.Research conclusions:1.With the development of basic public health services,the number of follow-up visits for patients with hypertension and diabetes mellitus in Jiaonan had been significantly increased,but there were still many people who failed to meet the standard follow-up requirements,and the standard follow-up rate still needed to be improved.2.The intervention effect of standardized management on exercise was better,that is,the exercise behavior of patients with sufficient follow-up times and sufficient follow-up content was easier to improve.3.Medication intervention can improve the control rate of blood pressure and blood glucose,and had a positive effect on most patients.4.The compliance of hypertension and diabetes management was poor.5.The combination of BART method and propensity score matching method can evaluate the individualized efficacy of patients after intervention,and find out the subgroup with high efficacy through subgroup analysis and summarize its characteristics.Based on this result,the individualized medication of patients can be directed,and the effect and efficiency of community intervention can be greatly improved.