Klocek Marek, Kawecka-Jaszcz Kalina
I Klinika Kardiologii, Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie, 31-501 Kraków, ul. Kopernika 17.
Przegl Lek. 2003;60(2):92-100.
Currently, one of the methods of comprehensive evaluation of patient health status is quality of life assessment. In the management of hypertension, evaluation of quality of life helps in individualization of therapy and improves its efficiency. The aim of the study was to compare the general quality of life between patients with essential hypertension and normal blood pressure values, and to analyse the effect of socio-demographic factors on the quality of life. An open questionnaire was distributed among 1539 patients (775 men and 764 women), aged from 18 to 88 years (x = 51.7 +/- 14.6 years) with essential hypertension detected at least 3 months earlier, referring to treatment for the first time or already treated by general practitioners and the Outpatient Department on Hypertension of the I Cardiac Department. Hypotensive treatment was given to 82.6% of the subjects, whereas 17.4% were untreated. A group of 995 subjects (459 men and 536 women) aged from 18 to 82 years (x = 48.6 +/- 11.2 years) with normal blood pressure values served as controls. All subjects provided data on education employment, body mass index, duration of arterial hypertension, family history, target organ damage, co-morbidity, blood pressure value, heart rate and pharmacological treatment. All subjects filled out a standardised questionnaire--Psychological General Well-Being (PGWB), which evaluated the general quality of life and its sin dimensions: Anxiety, Depressive mood, Subjective Well-being, Self-control, General health and Vitality. Statistical analysis included descriptive statistics, analysis of variance and multiple regression. The general quality of life in patients with essential hypertension was significantly lower than that in age-matched normotensives. The quality of life in women was lower than that in men irrespective of arterial hypertension presence. The quality of life was decreasing with age both in hypertensive and normotensives; however in hypertensive men there was a trend towards improved quality of life above 65 years of age in contrast to age-matched women in whom the quality of life deteriorated. The quality of life in untreated hypertensives was lower than that in age-matched healthy subjects, but until 40 years of age was higher than in treated age-matched hypertensives. The quality of life was related to the level of education, employment and familial history of hypertension. A lower quality of life was observed among hypertensives with coronary heart disease and diabetes. Multiple regression analysis revealed that gender, education, age and familial hypertension were the socio-demographic factors, which independently affected the quality of life among hypertensives. These factors accounted for 32.7% of the observed variance of quality of life. In normotensives subjects the independent factors were gender, age, education and employment--accounting for 65.8% of variance of quality of life.
目前，患者健康状况综合评估的方法之一是生活质量评估。在高血压管理中，生活质量评估有助于实现治疗个体化并提高治疗效果。本研究的目的是比较原发性高血压患者与血压正常者的总体生活质量，并分析社会人口学因素对生活质量的影响。向1539例患者（775例男性和764例女性）发放了开放式问卷，这些患者年龄在18至88岁之间（x = 51.7 +/- 14.6岁），至少在3个月前被诊断为原发性高血压，首次前来接受治疗或已由全科医生及心脏一科高血压门诊进行治疗。82.6%的受试者接受了降压治疗，而17.4%未接受治疗。选取995例年龄在18至82岁之间（x = 48.6 +/- 11.2岁）血压正常的受试者作为对照组。所有受试者提供了有关教育程度、就业情况、体重指数、动脉高血压病程、家族史、靶器官损害、合并症、血压值、心率及药物治疗的数据。所有受试者填写了一份标准化问卷——心理总体幸福感量表（PGWB），该量表评估总体生活质量及其六个维度：焦虑、抑郁情绪、主观幸福感、自我控制、总体健康和活力。统计分析包括描述性统计、方差分析和多元回归分析。原发性高血压患者的总体生活质量显著低于年龄匹配的血压正常者。无论是否患有动脉高血压，女性的生活质量均低于男性。高血压患者和血压正常者的生活质量均随年龄增长而下降；然而，65岁以上的高血压男性生活质量有改善趋势，而年龄匹配的女性生活质量则恶化。未接受治疗的高血压患者的生活质量低于年龄匹配的健康受试者，但在40岁之前高于年龄匹配的接受治疗的高血压患者。生活质量与教育程度、就业情况及高血压家族史有关。患有冠心病和糖尿病的高血压患者生活质量较低。多元回归分析显示，性别、教育程度、年龄和高血压家族史是独立影响高血压患者生活质量的社会人口学因素。这些因素占生活质量观察方差的32.7%。在血压正常的受试者中，独立因素为性别、年龄、教育程度和就业情况——占生活质量方差的65.8%。
