Foss F A, Dickinson E, Hills M, Thomson A, Wilson V, Ebrahim S
Department of Public Health and Primary Care, Royal Free Hospital Medical School, London.
Br J Gen Pract. 1996 Oct;46(411):571-5.
High-risk strategies for the prevention of cardiovascular disease (CVD) among hypertensive patients require knowledge of the prevalence and interaction of modifiable risk factors to ensure effective targeting of interventions. Comparatively little is known of risk-factor profiles and their modification among hypertensives in primary care.
The present study was designed to explore relationships between patients' knowledge of CVD risk factors, their perception of personal risk and health behaviours, and their use of lifestyle interventions.
A cross-sectional survey of 2676 men and women with mild to moderate hypertension (diastolic blood pressure 95-115 mmHg), and their general practitioners, recruited from 1044 general practices throughout the UK, was conducted.
Levels of modifiable risk factors were high, although there was considerable variation by age and sex; most (98.5%) patients had at least one additional CVD risk factor. A lower standard of living was associated with a higher prevalence of 'unhealthy' behaviours. Out of those with a current lifestyle problem, 85% of obese patients, 59% of smokers, 47% of excess drinkers, 49% of those with dietary risk factors and 32% of inactive patients claimed to have adopted healthier behaviours within the past 3 months. Older subjects and those with a lower standard of living were less likely to acknowledge risks, and those who did were less likely to report improving their lifestyles. While 71% of patients recalled receiving lifestyle advice, the coverage and targeting of specific interventions was generally poor. Overall, 60% of the sample had received advice on weight control, 47% on diet, 38% on exercise, 38% on smoking and 36% on alcohol. Women and older people were less likely to be given relevant counseling, and there was no evidence of targeting with respect to subjects' social class, level of hypertension or duration of diagnosis.
Lifestyle interventions are welcomed and are viewed as helpful by patients receiving them. Potential health gains among high-risk hypertensives are being lost because of poor targeting and coverage of those at greatest risk.
高血压患者预防心血管疾病（CVD）的高风险策略需要了解可改变风险因素的患病率及其相互作用，以确保干预措施的有效针对性。对于初级保健中高血压患者的风险因素概况及其改变情况，人们了解得相对较少。
本研究旨在探讨患者对CVD风险因素的认知、对个人风险和健康行为的感知以及他们对生活方式干预措施的使用之间的关系。
对从英国1044家全科诊所招募的2676名轻度至中度高血压（舒张压95 - 115 mmHg）男女患者及其全科医生进行了横断面调查。
可改变风险因素的水平较高，尽管存在年龄和性别差异；大多数（98.5%）患者至少还有一种其他CVD风险因素。较低的生活水平与“不健康”行为的较高患病率相关。在目前存在生活方式问题的患者中，85%的肥胖患者、59%的吸烟者、47%的过量饮酒者、49%有饮食风险因素的患者以及32%不活动的患者声称在过去3个月内采取了更健康的行为。年龄较大的受试者和生活水平较低的人不太可能认识到风险，而那些认识到风险的人报告改善生活方式的可能性较小。虽然71%的患者回忆起接受过生活方式建议，但具体干预措施的覆盖范围和针对性普遍较差。总体而言，60%的样本接受过体重控制建议，47%接受过饮食建议，38%接受过运动建议，38%接受过吸烟建议，36%接受过饮酒建议。女性和老年人接受相关咨询的可能性较小，而且没有证据表明针对受试者的社会阶层、高血压水平或诊断时长进行了针对性干预。
生活方式干预受到欢迎，接受干预的患者认为其有帮助。由于对最高风险人群的针对性和覆盖范围不佳，高危高血压患者潜在的健康获益正在流失。
