Fang Xiang-hua, Wang Wen-zhi, Wu Sheng-ping, Li Shi-chuo, Cheng Xue-ming, Du Xiao-li, Bao Qiu-ju
Department of Epidemiology and Social Medicine, Xuanwu Hospital, Capital University of Medical Science, Beijing 100053, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2003 Jul;24(7):538-41.
To evaluate the community-based intervention on reduction of hypertension and stroke in different age groups and subtypes hypertension.
In 6 cities, 2 geographically separated communities with a registered population about 10 000 of each were selected as either intervention or control communities. A cohort containing 2 700 subjects, 35 years or older, and free of stroke were sampled from each community. The baseline survey was conducted to screen the subjects for intervention. In each city, a program for control of hypertension, heart diseases and diabetes was initiated in the intervention cohort and health education was provided to the whole intervention community. A follow-up survey was conducted 3 years later.
Within 3 years, the prevalence of hypertension increased in both intervention and control cohorts, as well as in the middle and elderly cohorts, especially in the middle aged in control group. Among hypertensives in the intervention cohort, the rates of awareness, treatment and control of hypertension got improved. The incidence of stroke was 29% lower (HR = 0.71, 95% CI: 0.58 - 0.87) and mortality of stroke was 40% lower (HR = 0.60, 95% CI: 0.42 - 0.86) in the intervention cohort than the control cohort. The intervention was most effective in reduction of stroke for those with isolated systolic hypertension and combined systolic and diastolic hypertension (All P < 0.05). Meanwhile, all-cause mortality was 11% lower (HR = 0.89, 95% CI: 0.78 - 0.99) in the intervention cohort than in the control cohort.
The community-based intervention was effective in controlling the development of hypertension and stroke, while the elderly people benefit more than the middle aged people from the intervention.
评估基于社区的干预措施对不同年龄组及高血压亚型人群高血压和中风的降低效果。
在6个城市中，选取2个地理上相互分开、每个社区常住人口约1万的社区作为干预社区或对照社区。从每个社区中抽取一个包含2700名35岁及以上且无中风病史的受试者队列。进行基线调查以筛选干预对象。在每个城市，对干预队列启动高血压、心脏病和糖尿病控制项目，并对整个干预社区进行健康教育。3年后进行随访调查。
3年内，干预队列和对照队列、中年和老年队列中的高血压患病率均有所上升，尤其是对照组中的中年人。干预队列中的高血压患者，其高血压知晓率、治疗率和控制率均有所提高。干预队列中的中风发病率比对照队列低29%（HR = 0.71，95% CI：0.58 - 0.87），中风死亡率比对照队列低40%（HR = 0.60，95% CI：0.42 - 0.86）。该干预措施对单纯收缩期高血压和收缩压合并舒张压高血压患者降低中风的效果最为显著（所有P < 0.05）。同时，干预队列中的全因死亡率比对照队列低11%（HR = 0.89，95% CI：0.78 - 0.99）。
基于社区的干预措施在控制高血压和中风的发展方面有效，且老年人从该干预措施中获益比中年人更多。
