A Randomized Controlled Study On The Effect Of Comprehensive Core Intervention Based On Self-management Support On Blood Pressure Control In Elderly Hypertensive Patients In The Community

Objective To study the effect of Integrated core intervention based on self-management support on blood pressure control in elderly hypertensive patients and its influencing factors,with a view to selecting and optimizing the comprehensive prevention and treatment strategies for blood pressure control and health management for elderly hypertensive patients in the community,saving health resources,Improve patient self-management ability and blood pressure control effect to provide scientific reference.level.Methods1 A Network Meta analysis of Randomized Controlled Studies on the Effects of Different Intervention Methods In 6 domestic and foreign databases,including Pubmed database and Cochrane Library,collected research literature data on the effects of blood pressure control interventions in hypertensive patients from January 1,2010 to December 31,2019 for network meta-analysis.A total of 60 interventions including exercise intervention,diet intervention,self-blood pressure monitoring,psychological intervention,consultation and communication,health education,and lifestyle intervention were finally included.The included study included 4402 cases in the intervention group and 4,343 in the control group.For example,the duration of the intervention is 0.5-60 months.Outcome indicators(diastolic blood pressure and systolic blood pressure)combined effect size is expressed by the mean difference(MD)and its 95%CI;and a publication bias analysis(sensitivity analysis and Egger linear regression analysis)is performed to determine the effect of different intervention methods on patients’ blood pressure The control effects are ranked,and the most likely results of the effectiveness of blood pressure control in hypertensive patients are evaluated.2 A randomized controlled study on the effect of Integrated core intervention based on self-management support on blood pressure control in elderly hypertensive patients A total of 372 research subjects were recruited through on-site publicity and mobilization based on the hypertensive patients 65 and above in the archives of a community health service center in a city of Fuzhou City,based on the principle of voluntary participation.The computer random number table method was used,according to 1: 1 Grouping principle,the research subjects are randomly divided into intervention group and control group,and a randomized controlled study of the effect of Integrated core intervention based on self-management support on blood pressure control in elderly hypertensive patients is carried out.First,based on the previous research,determine the core intervention content,namely low-salt diet,regular walking exercise,self blood pressure monitoring,regular and quantitative medication,adhere to communication with doctors,work and rest management,emotional management(relaxation training)and maintenance Good lifestyle(quit smoking and limit alcohol);then,through on-site lectures,on-site consultation and guidance,distribution of relevant knowledge and core content of self-management,telephone follow-up,etc.,self-management support for the intervention group,and self-management behavior guidance twice a month And follow-up for a period of 1 year.The control group still received regular community education and health management,and collected blood pressure records.Before the intervention,during the intervention,and at the end of one year after the intervention,the blood pressure measurement values were collected to study the intervention effect.3 Analysis of the influencing factors of the Integrated core intervention effect of self-management support Based on the above randomized controlled study,a questionnaire survey of blood pressure control status and other related information,self-management behavior and ability of all intervention groups and control groups was conducted before and after the intervention,and the relationship between self-management behavior and blood pressure control effect and its relationship were compared and analyzed.Influencing factors.The blood pressure levels between the two groups were compared by independent sample t test and paired sample t test;follow-up blood pressure changes were analyzed by two-factor repeated measures analysis of variance;self-management score changes were analyzed and compared by non-parametric rank sum test and Wilcoxon signed ranks;self-management The comparison of behavior and its improvement rate adopts χ~2 test;the analysis of influencing factors affecting blood pressure control effect adopts multi-factor Logistic regression analysis.Results1 A Network Meta analysis of Randomized Controlled Studies on the Effects of Different Intervention Methods After the preliminary screening,a total of 14,320 literatures were retrieved.Through reading titles and abstracts,a total of 606 literatures related to the intervention effects of different life interventions for hypertension were screened out.After strict screening,they were finally included including exercise intervention,diet intervention,and diet intervention.Seven interventions including self-blood pressure monitoring,psychological intervention,consultation and communication,health education,and lifestyle interventions are included in60 articles.The results show that the included literature has good consistency with systolic blood pressure as the outcome indicator(P<0.05).According to the p-Score value,the different intervention methods of the systolic blood pressure control effect in hypertensive patients are ranked,in order: health education>psychological intervention>exercise intervention>communication with doctor>self blood pressure monitoring>diet intervention>lifestyle intervention>routine management.Taking diastolic blood pressure as the outcome indicator,the inconsistency test was not statistically significant(P>0.05),and descriptive scores were made.The results showed that routine management and psychological intervention have a greater possibility of affecting the effectiveness of diastolic blood pressure in patients with hypertension.The results of publication bias analysis showed that there was no publication bias in the included literature(Egger=0.533>0.05).2 A randomized controlled study of the effect of Integrated core intervention based on self-management support on blood pressure control in elderly hypertensive patients Before the intervention,the intervention group and the control group were comparable in terms of general information and disease-related characteristics(P>0.05);the baseline data of the self-management indicators showed that the intervention group and the control group were in self-management behaviors(including exercise,diet,etc.).,Blood pressure monitoring,medication compliance management,communication with doctors,work and rest management and emotional management)and self-efficacy indicators are balanced and comparable(P>0.05).(1)Blood pressure control: After the intervention,the systolic blood pressure of the core comprehensive management group was 135.8±8.3 mm Hg,the diastolic blood pressure was78.8±9.9 mm Hg,the systolic blood pressure of the control group was 138.3±9.9 mm Hg,and the diastolic blood pressure was 81.3±8.3 mm Hg,and Compared with the control group,the difference between the two groups was statistically significant in systolic and diastolic blood pressure(P<0.05).Comparison of blood pressure levels between the two groups before and after the intervention: In terms of systolic blood pressure,the SBP of the core comprehensive management group decreased by 2.2mm Hg,and the SBP of the control group increased by1.4 mm Hg.There was no statistically significant difference between the two groups before and after the changes in systolic blood pressure(P>0.05).In terms of diastolic blood pressure,the core comprehensive management group increased by 2.1mm Hg and the control group increased by 4.7mm Hg.The difference in diastolic blood pressure before and after the two groups was statistically significant(P<0.05).After the intervention,the blood pressure control rate of the core comprehensive management group was 64.42%,an increase of 1.85%compared with the baseline,and the blood pressure control rate of the control group dropped from 60% to 49.29%.(2)Blood pressure fluctuation: using two-factor repeated measurement analysis,P<0.05 after Mauchly’s spherical hypothesis test,the systolic blood pressure and diastolic blood pressure as dependent variables do not satisfy the spherical distribution.The results showed that the difference in systolic blood pressure between the two groups during the 1-year follow-up cannot be considered statistically significant(P>0.05).The change of systolic blood pressure over time was statistically significant(P<0.05),and there was an interaction between group and time(P=0.045).Different intervention methods(comprehensive core intervention and community routine management)have different changes in the diastolic blood pressure of elderly hypertensive patients in the community with follow-up time,but there is no interaction between group and time(P>0.05).(3)Comparative analysis of self-management behavior: After 1 year of intervention,the intervention group’s self-management in self-management behavior(diet,blood pressure monitoring,medication compliance management,communication with doctors,work and rest management,and emotional management)and self-efficacy The scores were better than those of the control group,and the difference between the groups was statistically significant(P<0.05),while the difference in sports management between the two groups was not significant(P>0.05).Compared with the control group,the improvement rate of the core comprehensive management group in diet management,self blood pressure monitoring,communication management with doctors,work and rest,emotional management and other behaviors was statistically different(P<0.05).3 Analysis of the influencing factors of the Integrated core intervention based on self-management support on the control of hypertension and blood pressure in the elderly in the community The results of multivariate logistic analysis showed that family history,age,diet management and communication management with doctors are important factors affecting the blood pressure control effect of elderly hypertensive patients in the community.Compared with those without a family history of hypertension,those with a family history of hypertension are 2.090 times more likely to have poor blood pressure control;compared with those aged ≥80 years old,those aged 65 to 80 are more likely to have good blood pressure control;Compared with those who did not follow a low-salt diet(OR=0.606,95%CI:0.373-0.982),those who had a low-salt diet were more likely to control blood pressure;those who insisted on communicating with a doctor were compared with those who did not communicate with a doctor(OR=0.589,95%CI: 0.356-0.973),it is more likely to control blood pressure.Conclusion(1)Compared with general health management,health education,psychological intervention,exercise intervention,consultation and communication management,self-blood pressure monitoring,and diet intervention have more obvious effects on systolic blood pressure control in hypertensive patients,but the effect on diastolic blood pressure control is not yet clear.(2)Comprehensive core intervention based on self-management support can control systolic and diastolic blood pressure in elderly hypertensive patients,and improve blood pressure control rate.(3)Comprehensive core interventions based on self-management support can improve self-management behaviors(diet,communication with doctors,etc.)of hypertensive patients and enhance self-efficacy.Factors affecting the effect of comprehensive core intervention on blood pressure control in elderly hypertensive patients in the community include family history,age,diet management,and communication management with doctors.Diet management should adhere to low-salt diet behaviors,and communicating with doctors is to actively communicate with doctors about their health status.