Hozawa Atsushi, Shimazu Taichi, Kuriyama Shinichi, Tsuji Ichiro
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454-1015, USA.
J Hypertens. 2006 Jul;24(7):1265-71. doi: 10.1097/01.hjh.0000234105.23615.95.
Many hypertensive individuals are not under medical management. We studied whether incorporating home blood pressure measurement and subsequent tailored advice into the primary care system improved hypertension management among untreated hypertensive individuals (screening systolic blood pressure >or= 140 mmHg or diastolic blood pressure >or= 90 mmHg and not taking antihypertensive medication) diagnosed during a community screening.
All residents aged 30 years or older in one district were asked to measure their blood pressure at home for 30 days, then received tailored advice (intervention area). Four of five Japanese districts served as a control. A self-administered questionnaire monitored the awareness and treatment of hypertension.
Eighty-eight per cent (106/120) of untreated hypertensive individuals in the intervention area measured home blood pressure. Of men and women meeting the criteria for untreated hypertension at a community screening in 2003, 97 intervention and 390 control individuals were rescreened in 2004. Among the untreated 2003 screening hypertensive individuals with home hypertension (home systolic blood pressure >or= 135 mmHg or diastolic blood pressure >or= 85 mmHg), the proportion not starting antihypertensive medication was 56%, and the proportion taking 'no action against hypertension' was 41%. These proportions were lower than in the control group (76%, 60%), yielding odds ratios (95% confidence interval) of 0.38 (0.21-0.68) and 0.42 (0.24-0.75), respectively.
Incorporating home blood pressure measurement coupled with tailored advice into the primary care system has the potential to reduce the risk of untreated hypertension.
许多高血压患者未接受药物治疗。我们研究了将家庭血压测量及后续的个性化建议纳入初级保健系统是否能改善社区筛查中确诊的未治疗高血压患者（筛查收缩压≥140 mmHg或舒张压≥90 mmHg且未服用抗高血压药物）的高血压管理情况。
要求某一地区所有30岁及以上居民在家测量血压30天，然后接受个性化建议（干预区）。日本五个地区中的四个作为对照。通过一份自填式问卷监测高血压的知晓率和治疗情况。
干预区88%（106/120）的未治疗高血压患者进行了家庭血压测量。在2003年社区筛查中符合未治疗高血压标准的男性和女性中，2004年对97名干预组和390名对照组个体进行了重新筛查。在2003年筛查出的未治疗高血压且有家庭高血压（家庭收缩压≥135 mmHg或舒张压≥85 mmHg）的个体中，未开始服用抗高血压药物的比例为56%，“未采取抗高血压措施”的比例为41%。这些比例低于对照组（分别为76%和60%），优势比（95%置信区间）分别为0.38（0.21 - 0.68）和0.42（0.24 - 0.75）。
将家庭血压测量与个性化建议纳入初级保健系统有可能降低未治疗高血压的风险。
