Influencing Factors,Triggering Factors And General Practice Intervention In Hypertensive Emergency

Objective To study the influencing factors,triggering factors and intervention effect of general practice in hypertensive emergency,and to provide basis for general practice to implement targeted intervention measures.Methods A total of 392 patients with hypertension who were admitted to the Second Affiliated Hospital of Guangxi Medical University from December2019 to December 2020 were selected.According to the occurrence of hypertensive emergency,they were divided into non-hypertensive emergency group(n=223)and hypertensive emergency group(n=169).The patients’ age,gender,ethnicity,waist circumference,body mass index(BMI),drinking history,educational level,course of hypertension,history of diabetes,family history of hypertension,exercise status,sleep status and family blood pressure monitoring(HBPM)were collected.Expose to surgery/trauma,stressful events,forced defecation,severe mood changes,binge-eating,weather changes,spontaneous withdrawal or dosing,general practice interventions,etc.,prior to onset of disease or 3 days prior to treatment.The clinical data of the two groups were compared,and multivariate Logistic stepwise regression analysis was used to explore the influencing factors of hypertensive emergency.Results 1.A total of 392 patients with hypertension were included in this study,including 169 patients in the hypertension emergency group,accounting for 43.1%,and the proportion of target organ damage was as follows: Acute coronary syndrome 33.1%,cerebral infarction 25.4%,left heart failure 11.8%,hypertension with intracranial hemorrhage 8.3%,hypertensive encephalopathy7.1%,aortic dissection 5.9%,and others 8.4%.2.There were no statistically significant differences between the two groups in gender,waist circumference,BMI,drinking history,educational level,pre-disease exposure to surgery/trauma,stressful events,forced defecation,severe mood change and overeating(P>0.05).There were statistically significant differences between the two groups in terms of age,course of hypertension,smoking history,diabetes history,family history of hypertension,exercise status,ethnicity,sleep status,HBPM status,general practice intervention status,exposure to weather change at the early stage of disease,self-withdrawal or addition of medication(P < 0.05).3.Among the 169 patients in the hypertension emergency group,annual physical examination accounted for 36.7%,follow-up 28.4%,assessment and education 26.6%,follow-up 15.4%,referral 5.9%,and annual physical examination 63.2% among the 223 patients in the non-hypertension emergency group.56.5% of the patients received follow-up visits,52.9% of the patients received evaluation and education,10.3% of the patients received follow-up visits,and 7.2% of the patients received referrals.The number of cases receiving general intervention between the two groups was compared,and the difference was statistically significant.4.Logistic regression analysis showed that Age(OR=1.062,95%CI1.028 ～ 1.098,P < 0.001),history of diabetes mellitus(OR=3.822,95%CI1.595～ 9.161,P=0.003),duration of hypertension(OR=1.085,95%CI 1.037～1.134,P < 0.001),non-Han nationality(OR=2.049,95%CI 1.086 ～3.866,P=0.027),sleep disorders(OR=2.033,95%CI 1.004 ～ 4.116,P=0.049),self-discontinued OR added medication(OR=16.853,95%CI 3.892 ～72.973,P<0.001),weather change(OR=4.124,95%CI 1.185～14.360,P=0.026)were the risk factors for hypertension emergency.Adherence to exercise(OR=18.174,95%CI 4.139～79.813,P<0.001),adherence to HBPM(OR=0.168,95%CI 0.088 ～ 0.324,P<0.001),general practice intervention(OR=0.074,95%CI 0.038 ～ 0.142,P < 0.001)were the protective factors for the occurrence of hypertension emergency.Conclusion 1.Age,non-Han nationality,history of diabetes mellitus,course of hypertension and sleep disturbance are the risk factors of hypertension emergency.2.Exposure to weather changes,withdrawal of medication or addition of medication in the early stage of disease are the trigger factors of hypertension emergency.3.Insist on exercise and HBPM,and strengthen general practice intervention as the protective factors of hypertension emergency.4.General practitioners should strengthen the health management of hypertensive patients,which is of certain significance to reduce the occurrence of hypertensive emergency.