Tan N C, Khin L W, Pagi R
SingHealth Polyclinics, Singapore.
J Hum Hypertens. 2005 Jul;19(7):559-64. doi: 10.1038/sj.jhh.1001865.
Hypertension is a principal cause of mortality and morbidity in Singapore. The use of home blood-pressure monitoring (HBPM) to assess hypertensive control with digital devices in the local multi-racial population is unknown. The study determined the factors associated with hypertensive patients' use of HBPM in primary care in a multi-racial Asian population. Randomized cross-sectional questionnaire survey of hypertensive patients managed in a district polyclinic. A model predicting use of HBPM was constructed by univariate and multivariate logistic regression. A total of 224 eligible subjects were randomly selected from 1943 patients. Response rate was 78.1% (n = 175). In all, 61.7% of them were aware of HBPM but only 24% used HBPM. Using multivariate analysis by stepwise backward regression, the final fitted model showed that HBPM was associated with higher patients' socioeconomic status: (adjusted OR for middle-income status = 2.85, 95% CI: 1.2-6.78, P = 0.018; adjusted OR for high-income status = 3.46, 95% CI: 1.22-9.87, P = 0.020) and their documented diastolic BP (adjusted OR for diastolic BP > 80 mmHg = 2.26, 95% CI: 1.06-4.82, P = 0.034). Nonusers cited failure to recognize benefits (54.1%), lack of HBPM awareness (29.3%), understanding of device operation (18.8%) and perception of inaccuracy (10.5%) as deterrents. 76.2% of users were satisfied with HBPM but lacked knowledge in maintenance of devices. In conclusion, 61.7% of the study population were aware of HBPM but only 24% used it. Patients' failure to recognize benefits, lack of awareness, cost and perception of inaccuracy were barriers. Higher socioeconomic status and patient's documented diastolic BP correlated with HBPM usage.
高血压是新加坡死亡率和发病率的主要原因。在当地多民族人群中，使用家庭血压监测（HBPM）数字设备评估高血压控制情况尚不清楚。该研究确定了在多民族亚洲人群的初级保健中，与高血压患者使用HBPM相关的因素。对在地区综合诊所接受治疗的高血压患者进行随机横断面问卷调查。通过单变量和多变量逻辑回归构建了一个预测HBPM使用情况的模型。从1943名患者中随机选取了224名符合条件的受试者。回复率为78.1%（n = 175）。其中，61.7%的人知晓HBPM，但只有24%的人使用HBPM。通过逐步向后回归进行多变量分析，最终拟合模型显示，HBPM与患者较高的社会经济地位相关：（中等收入状态的调整后OR = 2.85，95%CI：1.2 - 6.78，P = 0.018；高收入状态的调整后OR = 3.46，95%CI：1.22 - 9.87，P = 0.020）以及他们记录的舒张压（舒张压>80 mmHg的调整后OR = 2.26，95%CI：1.06 - 4.82，P = 0.034）。未使用者将未认识到益处（54.1%）、缺乏HBPM意识（29.3%）、对设备操作的理解（18.8%）和对不准确的认知（10.5%）视为阻碍因素。76.2%的使用者对HBPM感到满意，但在设备维护方面缺乏知识。总之，61.7%的研究人群知晓HBPM，但只有24% 的人使用它。患者未认识到益处、缺乏意识、成本和对不准确的认知是障碍。较高的社会经济地位和患者记录的舒张压与HBPM使用相关。
