| BackgroundHypertension is already a highly prevalent risk factor for cardiovascular disease (CVD) throughout the industrialized as well as developing world, China included, too.Theoretically; Hypertension is among those chronic diseases which are considered easy to be controlled. It is becoming an increasingly common health problem, however, not only in China but all over the world because of increasing longevity and prevalence of contributing factors such as obesity, physical inactivity and an unhealthy diet. According to the survery performed in 2003 by GU Dongfeng et al, the morbidity rate of hypertension among the Chinese adult aged from 35 to 74 was 27.2%, which meant approximately 1.3 hundred million hypertensive patients in China that time. Among these patients,44.7% were aware of their diagnosis,28.2% were taking medicine, only 8.1% were successful to low their blood pressre to target level(<140/90mmHg). Worldwide hypertension is estimated to cause 7.1 million premature deaths and 10% of the disease burden.Lifestyle modification is a critical component of population-based strategies to prevent hypertension. The risk factors for hypertension are over-weight, high sodium intake and excessive alcohol consumption. Since the lack of community health care system and insufficient support for hypertensive patients, poor compliance of intention, life style, attitude, responsibility, smoking or drug therapy was common in these patients. Significant progress has been made in increasing the awareness, detection, treatment, and control of hypertension; however, studies indicate that about 50%～75% of patients diagnosed with or being treated for HTN do not have adequate control of their blood pressure (BP). Efforts to control HTN have included increasing public knowledge and awareness, especially about the compliance of both drug and non-drug therapy as well as life style.According to the "knowledge, attitude, belief and practice (KABP)" theory, knowledge could lead to correct belief as well as behaviour.The available evidence supports the notion that the prognostic value of self blood pressure monitoring, which also known as home blood pressure monitoring(HBPM), is equal to or higher than that of OBP, a method which, at present, remains the point of reference for prognostic stratification and clinical decision making in hypertension. HBP was more closely associated with the risk of cardiovascular mortality than OBP; Compared with OBP, HBP was more closely associated with the risk of stroke, cardiovascular events. In patients with chronic kidney disease, HBP is a better predictor of progression to end stage renal disease.The aim of this study is to 1) investigate knowledge, compliance, and chronic disease associated life style as well as control rate in elderly hypertensive patients in Haizhu district of Guangzhou city; 2) evaluate the effect of self blood pressure monitoring on knowledge, self efficacy and behaviour in elderly hypertensive patients.Methods: 1.Part ITo investigate knowledge, compliance and life style, a face-to-face interview was performed by a questionnaire in hypertensive patients aged from 60 to 80 in some communities in Haizhu district of Guangzhou.972 patients were collected by randomized sampling. Patients with other severe diseases such as cancer and mental aberration were not included in the survey. The questionnaire included:1.1 General data including gender, age, education background and history of smoking and alcohol consumption.1.2 Blood pressure1.3 Hypertension knowledge1.4 Compliance1.5 Life style including weight, height, body mass index, diet, smoking and physical activey.2. PartⅡTo evaluate the effect of self blood pressure monitoring on knowledge, self efficacy and behaviour, elderly hypertensive patients were enrolled from the survey according to inclusion and exclusion criteria below:1) Aged from 60 to 80, being local resident at least 5 years, diagnosed as primary hypertension at least one year and taking at least one kind of anti-hypertensive drug;2) Capable of reading, listening, comprehension and communication by mandarin or cantonese;3) Owning a valid electronic sphygmomanometer;4) Did not perform self blood pressure monitoring a month before intervention. Eligible participants were randomly assigned to one of three groups:1) Advice Only (Standard of Care); 2) a behavioral intervention that includes established lifestyle recommendations,i.e., weight loss if overweight, reduced sodium intake, increased physical activity, and limited intake ofalcohol (Established); or 3) a behavioral intervention that includes the established recommendations in #2, plus self blood pressure monitoring.After intervention, knowledge, compliance, self-efficacy and behaviour were re-assessed by questionnaires.3. Data analysisSPSS 13.0 statistical software was used to analyze data. Data are presented as Mean±S.D. Statistical significance was determined in a multiple comparisons among different groups of data in which one-way ANOVA or independent t test indicated the presence of significant differences. Chi-square test was used to compare ratio or percentage in different groups. P value<0.05 was considered to be significant.Results:1. The control rate in hypertensive patients was 33.44%; the rate of the female was higher than that of the male(x2=5.235, P=0.025);2. Aareness of hypertension knowledge in success group was better than that of non-controlled patients, but not significant.3. Patients with normal BP showed better behaviour compliance than those with high BP;4. The average intake of salt in normal BP patients was 7.90±1.93g/d, which was lower than those with high BP(t=11.122, P<0.001);the average intake of oil in normal BP patients was 25.06±5.97g/d, which was lower than those with high BP(t=9.466, P<0.001); the average intake of vegetables in normal BP patients was 591.07±211.35g/d, which was lower than those with high BP(t=-12.209, P < 0.001); the average intake of fruits in normal BP patients was 127.49±108.40g/d, which was lower than those with high BP(t=-2.274, P< 0.001).5. Of total patients, the over-weight rate was 38.68% while the obesity rate was 11.83%; the average BMI in patients with normal BP was 22.37±3.48 kg/m2, which was lower than those with high BP(t=9,962, P<0.001);6. The smoking rate in patients with normal BP was 22.37±3.48 kg/m2, which was lower than those with high BP(x2=92.457, P<0.001);7. Through analyzing the influencing factors of success treatment of hypertension by logistic regression, eight were found to predict the outcome of hypertension treatment, including oil intake, BMI, circumference, behaviour compliance, et al.8. Compared with "Advice only" group, patients in the latter 2 groups raised significantly awareness of knowledge;9. Compared with "Advice only" group, patients in the latter 2 groups raised significantly self efficacy; Compared with "behaviour intervention" group, patients in "self blood pressure monitoring" group showed higher self efficacy level;10. Compared with "Advice only" group, patients in the latter 2 groups raised significantly behaviour compliance; Compared with "behaviour intervention" group, patients in "self blood pressure monitoring" group showed higher compliance level;11. Compared with "Advice only" group, patients in the latter 2 groups lowed significantly systolic and diastolic pressure; Compared with "behaviour intervention" group, patients in "self blood pressure monitoring" group showed lower BP;12. Compared with "Advice only" group, patients in the latter 2 groups lowered significantly systolic and diastolic pressure; Compared with "behaviour intervention" group, patients in "self blood pressure monitoring" group showed lower BP;13. Compared with "Advice only" group, patients in the latter 2 groups lowered significantly BMI, circumference, sodium and oil intake; Compared with "behaviour intervention" group, patients in "self blood pressure monitoring" group showed lower BMI, circumference, sodium and oil intake.Conclusions:1. Practice compliance (including intention, life style, attitude and responsibility), BMI, circumference, intake of vegetables and oil were found to be associated with success rate of hypertension therapy;2. Compared with traditional behaviour intervention, Self blood pressure monitoring could significantly raise awareness of knowledge, practice compliance, self efficacy and improve life style, which led to lower intake of salt and oil, blood pressre. |
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