Current Status Of Blood Pressure And Blood Sugar Control,Related Influencing Factors,Antihypertensive And Hypoglycemic Drugs In The Elderly Coronary Heart Disease Patients With Diabetes Mdlitus And Hypertension

[Objective]The elderly coronary heart disease patients with diabetes mdlitus and hypertension are considered as a special kind of high risk group of cardiovascular disease. Hypertension and diabetes mellitus are not only the significant risk factors for cardiovascular disease, but also the important merger disease resulting in poor prognosis of patients with coronary heart disease (CHD), therefore, it is important to understand the current status of blood pressure and blood sugar control, related influencing factors, antihypertensive and hypoglycemic drugs in these special patients combined with high blood pressure and diabetes. At present, the domestic still lack for such epidemiological reports in hese special patients. Therefore, this research in the survey, on the basis of Present situation on therapy and secondary prevention of coronary heart disease in the Chinese elderly, is aimed to investigate the current status of blood pressure and blood sugar control, related influencing factors, antihypertensive and hypoglycemic drugs in these special patients, and to improve the cognition of secondary prevention in the patients so as to provide references to improve the prognosis of these high-risk patients.[Methods]1.7962 cases of elderly patients were included in the survey,1379 cases were eventually selected from the total 7962 elderly patients, and to investigate the current status of blood pressure control, related influencing factors, antihypertensive drugs in these special patients.2.1018 cases of these patients voluntarily received the glycosylated hemoglobin (HbAlc) inspection, and to investigate the current status of blood sugar control, related influencing factors, hypoglycemic drugs in these special patients.[Results]1. The results of current status of blood pressure control, related influencing factors, antihypertensive drugs in these special patients.(1) 1379 cases of elderly coronary heart disease patients with DM and HP were selected from 7962 cases of elderly patients with CHD(accounted for 17.3%). (1) the control rate of blood pressure was 17.1% for antihypertensive target value< 130/80 mmHg; the success rate for achieving the target value<140/80 mmHg were only 27.5%; the control rate was39.6% for the target value< 140/90 mmHg; the success rate for achieving the target value< 150/90 mmHg were 51.7%; the control rate of the elderly patient aged 70 years or over gradually increased with increasing of age; success rate of elderly patient more than 85 years was the highest, whereas success rate of elderly patient aged71～71 years old were lowest; success rate in male patients were close to female patients, and success rate for men were slightly higher than those in women;(2) With the aim of blood pressure 140/90 mmHg, the single factor analysis showed that there were statistical differences in age, culture level, body mass index (BMI) and resting heart rate, cardiovascular disease family history, smoking history, drinking history, family history of hypertension, dyslipidemia, ischemic stroke/TIA proportion between the blood pressure the groups. Multivariable Logistic regression equation showed that the elementary school and the below(OR=1.572,95%CI:1.321 ～3.131), BMI>28.0kg/m2(OR=2.437,95%CI:1.438-4.329), resting heart rate≥80 times/min (OR=1.832,95%CI:1.130～2.431), smoking history (OR=1.335,95% CI:1.112～1.960), alcohol (OR=1.295,95%CI:1.041～1.554), dyslipidemia (OR= 1.790,95%CI:1.243～1.902) were positively correlated the poor blood pressure control (P<0.05), while age>80 years old (OR=0.586,95%CI:0.417～0.854) was negatively correlated with the poor blood pressure control (P<0.05).(3) Of 1379 subjects,1317 effective interviewed cases received antihypertensive therapy(effective interviewed rate was 97.8%); the most used drugs were angiotensin receptor blockers (ARB)/angiotensin converting enzyme inhibitors (ACEI) utilization rate (usage rate was 76.8%), followed by calcium channel blockers (CCB) (utilization rate was65.5%), beta-blockers (usage rate was 44.6%), thiazide diuretics (usage rate was 26.3%) respectively; (3) combination of two drugs was the most common way in antihypertensive medication (accounted for 41.2%), other ways were three drugs combination(accounted for 28.9%), method of single drug(23.9%); CCB were the common drugs in the way of single drug(accounted for 8.8%), CCB combined with ARB were the most common way in combination of two drugs(11.7%), CCB combined with ARB and β-blockers were frequently used in combination of three drugs(9.2%);(4)987 cases of patients received standard treatment recommended by guideline (accounted for 76.6%); the rate of standard usage in combination of two drugs was 71.9%, the rate of standard usage in combination of three drugs was 66.1%. 2. The results of current status of blood sugar control, related influencing factors, hypoglycemic drugs in these special patients.(1) Average level of HbAlC% for 1018 patients was (7.33±2.12)%, proportion of patients with HbAlc<6.5% and<7.0% was 23.5%(239/1018) and 51.2% (521/1018), respectively.(2) The single factor analysis showed that degree of culture, drinking, BMI, resting heart rate and duration of diabetes, dyslipidemia, and blood pressure control were with HbAlC<6.0%(P<0.05); and age, BMI, cultural level, resting heart rate, history of drinking, dyslipidemia, blood pressure control were with HbAlc<7.0% (P<0.05). Multiariable Logistic regression equation shows that the junior middle school, elementary school and the below, BMI>28.0kg/m2, resting heart rate>80 times/min, dyslipidemia, diastolic blood pressure and systolic blood pressure were positively correlated with poor blood sugar control(HbAlc<6.0%); while primary school and below, duration of diabetes, BMI>28.0kg/m2, resting heart rate ≥80 times/min, dyslipidemia, diastolic blood pressure and systolic blood pressure were positively correlated with poor blood sugar control(HbAlc<7.0%).(3) the overall treatment rate was 94.1%(958/1008) in the survey; a-glycosidase inhibitor was the most commonly prescribed hypoglycemic drugs (usage rate was 51.3%), followed by metformin (46.7%) and insulin (46.7%),combination medication was the main way of therapy(63.9%); treatment of oralantidiabetic drug (OAD) only accounted for 53.0%; insulin (INS) only accounted for13.9%% of insulin (INS), combination of INS and OAD accounted for 31.2%.; bloodsugar success rate of INS used only was 47.5(HbAlC<7.0%), OAD only was 59.5%and combination of INS and OAD was 34.3%; blood sugar success rate of single drugwas 60.2%; combination medication was 42.8%.[Conclusion] 1. The rate of this group elderly patient receiving antihypertensive therapy isrelatively high whereas the overall blood pressure control rate for different targetvalues changes a lot and is low. 2. The blood pressure control success rate are affected by many factors, the lowdegree of culture, obesity, excessively rapid heart rate, history of smoking, drinkingalcohol, dyslipidemia may be risk factors for poor blood pressure control. 3. ARB and ACEI are the major drugs in antihypertensive medication whilediuretic drugs are now rarely used; combined medication is the main method ofantihypertensive therapy where a substantial part of irregular medication not inconformity with the relevant guidelines recommend are found. 4. The overall rate of hypoglycemic therapy Is high in elderly coronary heartdisease patients with diabetes mellitus and hypertension, but overall blood sugarsuccess rate is low, blood sugar success rate is affected by many factors, low degree ofculture, obesity, excessively rapid heart rate, dyslipidemia, high blood pressure maybe independent risk factors of blood sugar success rate. there is much difference insuccess rates of such patients because of a variety of treatment, and a lot of problemswith drugs usage was found; measures should be made to strengthen the managementof such cases, especially positive control of blood pressure is made to improve bloodsugar success rate.