Study On Disease Status And Medication Of Elderly Hypertension Patients Under Community Standardized Management

Background With the acceleration of population ageing,the prevalence and incidence of chronic diseases continue to rise,the world is facing great challenges,especially the impact of high blood pressure can not be ignored.As the "gatekeeper" of residents’ health,community plays an important role in residents’ hypertension management.The effect of community health service institutions on the health management of elderly hypertension directly affects the health level and quality of life of residents.Objective（1）To investigate the status of blood pressure control and its influencing factors in elderly hypertension patients under community standardized management;（2）To investigate the morbidity and its influencing factors of elderly hypertension patients with combined diseases under community standardized management;（3）To investigate the quantity of medication and its influencing factors in elderly hypertension patients under community standardized management;（4）To provide scientific basis for the community to carry out better health management of elderly hypertension patients and improve their health status.MethodsSelected elderly hypertension patients who underwent health check-up in Hongguang Community Health Service Center from January 1,2020 to December 31,2020 and were included in the management standardized of the elderly and the management of hypertension diseases in the community,SPSS23.0 software for its analysis,including:（1）elderly hypertension patients in general demographic characteristics;（2）describe with frequency and percentage the situation of blood pressure control,the situation of combined diseases and the situation of the quantity of medication situation in the elderly hypertension patients;（3）single factor analysis and multi-factor analysis were used to analyze the influencing factors of blood pressure control,combined diseases and medication quantity in elderly hypertension patients.Results（1）A total of 1803 samples were obtained,of which 1041 were valid,with an effective rate of 57.7%.Only 587 patients（56.4%）suffered from hypertension and 454 patients（43.6%）suffered from hypertension combined with other diseases.In terms of gender composition,451 males accounted for 43.3%,while 590 females accounted for 56.7%.In the aspect of age,the average age of elderly patients with hypertension was 74.2 ±5.4,of which 222（21.3%）were aged from 65 to 70 years,and 341（32.2%）were aged from 70 to 75 years.There were 303 patients（29.1%）aged 75-80,147 patients（14.1%）aged 80-85,and 28 patients（2.7%）aged 85 or above.In the distribution of blood pressure,41.5% of the patients had systolic blood pressure in the normal high range,91.3% of the patients had diastolic blood pressure in the normal high range,and 429 patients had blood pressure control in the normal high range,accounting for 41.2%.In the quantity of drugs,90 patients（9.4%）were treated with three or more kinds of drugs.（2）There were 432（41.5%）of the elderly hypertension patients reached the standard of systolic blood pressure（SBP < 140 mm Hg）.The results of orderly logistics regression analysis showed that age,BMI,exercise,diet,history of drinking,management of traditional Chinese medicine and blood glucose were the influencing factors.There were 950（91.3%）of the elderly hypertension patients reached the standard of diastolic blood pressure（DBP < 90 mm Hg）.The results of orderly logistics regression analysis showed that sex,BMI,educational level,exercise,diet,heart rate and serum creatinine were the influencing factors.There were 429 persons（41.2%）who achieved the target of hypertension control（blood pressure < 140 mm Hg/90 mm Hg）.The results of binary logistic analysis showed that age,BMI,exercise,history of smoking,history of drinking,and whether to accept the management of traditional Chinese medicine were the influencing factors.（3）Elderly hypertension combined with other diseases in 454 cases,accounting for43.6% of the sample population.The results of binary logistic analysis showed that dietary habits,drinking history,medication adherence and blood glucose were the influencing factors of other diseases in elderly patients with hypertension.Elderly patients with hypertension combined with a disease more,370 people,combined with two diseases and three diseases were 72 and 12 respectively.The results of orderly logistics regression analysis showed that drinking,medication adherence and blood glucose were the influencing factors of the number of hypertension complicated diseases.Diabetes mellitus,coronary heart disease and stroke were the main complications in elderly patients with hypertension.Among them,312 cases（68.7%）were hypertension complicated with diabetes mellitus.The results of binary logistic analysis showed that medication adherence,Chinese medicine management and blood glucose were the influencing factors of hypertension complicated with diabetes.（4）Among the elderly patients with hypertension,76 patients who did not take medicine,653 patients（62.7%）took single medicine,and there were 5 kinds of drugs.The rate of using three or more drugs was 13.0% in 80-85 age group,which was higher than other age group.Among the different BMI groups,13.0% of obese people used three or more drugs.With the increase of blood glucose value,the proportion of the elderly patients with three or more drugs was increasing,the proportion of the high blood glucose group was 23.9%.The results of orderly logistics regression analysis showed that age,medication adherence,blood glucose and serum creatinine were the influencing factors.Conclusions（1）The control of systolic blood pressure was worse than that of diastolic blood pressure,and was consistent with the control of hypertension.Therefore,the community in the management of elderly hypertension should strengthen the systolic blood pressure changes in patients with concern and control.At the same time,as the influence factor of blood pressure control,the management of traditional Chinese medicine for the elderly should be paid attention to by the community,optimize its service content,and provide scientific and reasonable individualized service for patients.（2）Elderly patients with hypertension comorbidity phenomenon is obvious,most of the patients with a disease.Diabetes,coronary heart disease and stroke are the main complications of elderly patients with hypertension,among which diabetes mellitus is the most common.Therefore,the community should develop different disease management programs for patients with different diseases.In particular,hypertension and diabetes will be integrated management,in accordance with the service project to provide multi-perspective,multi-faceted,multi-range supervision services.（3）Single medication of elderly patients with high blood pressure in the majority,the proportion of combined medication is relatively low.In the patients with combined medication,the duplex medication medication was the most,and the quantity of drugs used was up to five kinds.The community should pay attention to the drug use of patients,do a good job of medication instruction,and promote rational drug use.At the same time,the community should speed up the establishment of electronic medication record,in order to master patients’ medication information,provide individualized pharmaceutical care,and improve health level.（4）The disease status of elderly patients with hypertension under standardized community management is influenced by many factors,among which,b MI,diet,exercise and medication adherence are important factors for blood pressure control,complication and drug use.The community should strengthen health education as well as health intervention to improve patients’ health literacy through regular health lectures,exercise activities for the elderly,health handbooks and peer education,to adjust the bad living habits,improve drug safety,improve health.