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[教育干预组对基层医疗中高血压患者生活方式改变的疗效:一项随机临床试验]

[Efficacy of an educational intervention group on changes in lifestyles in hypertensive patients in primary care: a randomized clinical trial].

作者信息

Rodríguez Martín Carmela, Castaño Sánchez Carmen, García Ortiz Luis, Recio Rodríguez José Ignacio, Castaño Sánchez Yolanda, Gómez Marcos Manuel Angel

机构信息

Unidad de Investigación, Centro de salud La Alamedilla, Salamanca.

出版信息

Rev Esp Salud Publica. 2009 May-Jun;83(3):441-52. doi: 10.1590/s1135-57272009000300009.

DOI:10.1590/s1135-57272009000300009
PMID:19701575
Abstract

BACKGROUND

Healthy lifestyles are associated with less risk of cardiovascular disease. The aim of this study is to evaluate the effectiveness of a group educational strategy in lifestyle changes, as well as the control of risk factors and cardiovascular risk in hypertensive patients.

METHODS

Randomized clinical trial carried out in Primary Care. 101 hypertensive patients were selected by random sampling, aged 35-74; 51 patients were randomized to the intervention group (IG) (aged: 64,5+/-9,7, 56% women) and other 50 to the control group(CG)(aged: 65,4+/-8,4, 68% women). We performed a basal evaluation and an educational intervention on lifestyles, six sessions during one year, and final-point evaluation. Effect of intervention was evaluated through of cardiovascular risk (Framingham), blood pressure, lipid profile, waist circumference, body mass index (BMI), nutrient consumption, physical exercise (7-PAR day) and quality of life(SF-36).

RESULTS

Basal blood pressure was 136,8/82,7 mmHg IG and 139,3/79,3 CG, cardiovascular risk was 11,1% y 12,3% respectively. Systolic blood pressure decreased 5,6+/-19,6 (p=0,07) IG and 7,1+/-16,3 mmHg (p=0,004) GC, and diastolic decreased 3,9+/-10,8 (p=0,02) and 2,7+/-11,5 mmHg (p=0,10) respectively. BMI decreased 0,3+/-1,6 points IG (p=0,17) and increased 0,1+/-1,5 CG (p=0,81). Coronary risk decreased 0,8+/-6,5 points IG and increased 0,2+/- 6,8 CG; effect of intervention was a reduction in 1 point (CI95%-3,9/1,9)(p=0,48). Calories ingestion decreased 42,8+/-1141,2 Kcal/day p=0,14) IG and 278,9+/-1115,9(p=0,62) CG. Physical exercise increased in both groups: 3,6+/-19 IG (p=0,20) and 3,9+/-14,9 mets/hour/week CG (p=0,07).

CONCLUSIONS

There was a higher decline of cardiovascular risk in the intervention group than control group, we did not find statistically significant differences between both groups in parameters evaluated.

摘要

背景

健康的生活方式与较低的心血管疾病风险相关。本研究的目的是评估团体教育策略在改变生活方式以及控制高血压患者危险因素和心血管风险方面的有效性。

方法

在初级保健机构进行随机临床试验。通过随机抽样选取101例年龄在35 - 74岁的高血压患者;51例患者被随机分配到干预组(IG)(年龄:64.5±9.7岁,女性占56%),另外50例被分配到对照组(CG)(年龄:65.4±8.4岁,女性占68%)。我们进行了基础评估、关于生活方式的教育干预(在一年中进行六次课程)以及终点评估。通过心血管风险(弗明汉)、血压、血脂谱、腰围、体重指数(BMI)、营养摄入、体育锻炼(每天7个代谢当量)和生活质量(SF - 36)来评估干预效果。

结果

干预组基础血压为136.8/82.7 mmHg,对照组为139.3/79.3 mmHg,心血管风险分别为11.1%和12.3%。干预组收缩压下降5.6±19.6(p = 0.07),对照组下降7.1±16.3 mmHg(p = 0.004);干预组舒张压下降3.9±10.8(p = 0.02),对照组下降2.7±11.5 mmHg(p = 0.10)。干预组BMI下降0.3±1.6个点(p = 0.17),对照组上升0.1±1.5(p = 0.81)。干预组冠心病风险下降0.8±6.5个点,对照组上升0.2±6.8;干预效果为降低1个点(95%置信区间 - 3.9/1.9)(p = 0.48)。干预组热量摄入下降42.8±1141.2千卡/天(p = 0.14),对照组下降278.9±1115.9(p = 0.62)。两组体育锻炼均增加:干预组增加3.6±19(p = 0.20),对照组增加3.9±14.9代谢当量/小时/周(p = 0.0

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