Effect Of Work-rest Management On Blood Pressure Control In Patients With Hypertension

Objective The relationship between self-management intervention and hypertensive patients' blood pressure control effect were systematically analyzed and the effect of work-rest management on hypertensive patients' blood pressure control and its influencing factors are studied,so as to provide reference for the optimization and selection of behavior intervention programs for hypertensive patients in China.Methods 1 Meta analysis Pubmed database and Cochrane Library were used to collect literatures on the effects of self-management intervention on blood pressure in patients with hypertension published up to December 31,2017.The combined effects(diastolic blood pressure and systolic blood pressure)were described by weighted mean difference(WMD)and its 95% CI,and published bias analysis(sensitivity analysis and Egger's linear regression method)was performed.2 Case-control study We collected the data of all hypertensive patients in a community of Fuzhou city for systematic sampling.A total of 538 patients were selected,269 cases in case group and 269 cases in control group.(1)According to the situation of blood pressure control,538 hypertensive patients were divided into good blood pressure control group(control group)and uncontrolled blood pressure group(case group).The basic information of the subjects(gender,age,monthly income per capita of the permanent population of the family,etc.),illness(years of illness,family history,etc.),and self-management(exercise management,diet)were collected through self-designed questionnaires to analyze the influencing factors of blood pressure control effect on patients with hypertension.(2)337 of 538 hypertensive patients with work-rest management according to their blood pressure control are grouped in order to analyze the relationship between work-rest management and blood pressure control effect.(3)538 hypertensive patients were divided into groups according to whether they had work-rest management or not.The relationship between work-rest management and gender,age,self-efficacy and other factors was analyzed.In the above analysis,the single factor was tested by ?2 test and the multifactor was analyzed by unconditional logistic regression model.3 Cohort study We collected the data of all hypertensive patients in a city community of Fuzhou and conducted a systematic sampling combined with the voluntary principle.A total of 600 hypertensive patients in the community were enrolled,and a cohort study was conducted with the blood pressure control rate as the outcome index.From May 2017 to May 2018,a unified questionnaire was used to collect general information(gender,age,education level,duration of illness,family history,etc.),exercise status,dietary status and blood pressure of 462 subjects at baseline and end points.The survey rate was 77%.The blood pressure control rate was compared by chi-square test based on whether to manage work and rest.Results 1 Meta analysis(1)Meta-analysis of the effect of self-management intervention on blood pressure in patients with hypertension showed that the effect of systolic blood pressure intervention in self-management intervention group was better than that in control group(WMD=-5.51,95% CI:-8.07-2.94);the effect of diastolic blood pressure intervention in intervention group was better than that in control group(WMD=-3.70,95% CI:-5.62-1.79),with statistical significance(P < 0.05).(2)There is no publication bias.2 Case-control study(1)The results of multivariate logistic analysis showed that the factors influencing blood pressure control of hypertension patients were: monthly income per capita of permanent population,exercise management,disease surveillance,work-rest management.(2)The single-factor logistic analysis of the influence of work-rest management on blood pressure control showed that there were correlations between the four behaviors of daily life,such as slowing down,doing housework properly according to blood pressure,resting when tired and adjusting working time,content and volume according to blood pressure(P < 0.05).(3)Compared with female patients,male patients paid less attention to work-rest management(OR = 1.930,95% CI: 1.329-2.803),and compared with patients with self-efficacy,those without self-efficacy paid less attention to work-rest management(OR = 2.659,1.820-3.884).(P < 0.05).3 Cohort study(1)In all the subjects,the blood pressure control rates of the management group and the control group were 50.38% and 43.37%,respectively.There was a significant difference in the blood pressure control rates between the two groups(P < 0.05).(2)Among the subjects with good blood pressure control,the blood pressure control rates of the management group and the control group were 95.52% and 85.53%,respectively.There was significant difference in the blood pressure control rates between the two groups(P < 0.05).(3)In the uncontrolled subjects,the blood pressure control rates of the management group and the control group were 7.58% and 9.91%,respectively.There was no significant difference between the two groups(P > 0.05).Conclusion(1)Self-management intervention plays a positive role in improving blood pressure control in patients with hypertension.Per capita monthly income,exercise management and disease surveillance of household permanent population can promote the effect of blood pressure control in patients with hypertension.(2)work-rest management is an important factor to promote the effect of blood pressure control in patients with hypertension.In the daily life of work-rest management,there are four behaviors related to blood pressure control: slowing down,doing housework properly according to blood pressure,resting when tired and adjusting working time,content and quantity according to blood pressure.Gender and self-efficacy can affect the management of work and rest in patients with hypertension.(3)work-rest management plays an important role in blood pressure control of patients with good blood pressure control,but the effect of blood pressure control of patients with poor blood pressure control is not obvious.