Page 49 - 中国全科医学2022-10

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1.Community Health Management Center，Shenzhen Luohu People's Group，Shenzhen 518005，China
2.Department of General Practice，Shenzhen University Health Science Center，Shenzhen 518061，China
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Corresponding author：YIN Zhaoxia，Chief physician，Professor，Master supervisor；E-mail：yinzhaoxia@163.com
【Abstract】 Background The low hypertension control rate or low glycemic control rate in people in the community have
been attributed to patients' poor disease awareness and irregular medication in some studies. However，few studies have explored
hypertension control rate and/or glycemic control rate in patients with good disease awareness and regular medication. Objective
To investigate the adequate hypertension control rate and/or adequate glycemic control rate in hypertension and diabetic patients who
are at high risk of atherosclerotic cardiovascular disease（ASCVD）but have good disease awareness and regular medication，and
to explore the reasons for poor control，offering a theoretical basis for better prevention and control of ASCVD. Methods By use
of cluster sampling，contracted patients with complete data of the China-PAR model who visited 10 community health centers in
Shenzhen's Luohu District from August 2018 to April 2019 were selected，and received an assessment for screening the risk of 10-
year ASCVD using the China-PAR model，and those with hypertension and/or diabetes who were at high risk of ASCVD（ ≥ 10
points）and volunteered to attend this study were further surveyed using a questionnaire developed by our research group. After that，
those who were on regular medication with a good understanding of the threats of hypertension and/or diabetes，and targets for blood
pressure control and/or fasting glycemia control，were finally enrolled. The rate of adequate hypertension control was compared
between those with hypertension，the rate of adequate glycemic control was compared between those with diabetes，and the rates of
adequate hypertension and glycemic control were compared between those with both hypertension and diabetes，by demographcihc
factors. Then those who were found with inadequate hypertension and/or glycemic control were selected to attend an in-depth，semi-
structured individual interview using a descriptive qualitative research design for understating the causes of inadequate hypertension
and/or glycemic control. The contents of the interview were coded and categorized using NVivo 12，and were sorted，analyzed，and
themes in which were identified using content analysis. Results Totally 299 patients were finally enrolled，including 130（43.5%）
with hypertension，9（3.0%）with diabetes，and 160（53.5%）with both hypertension and diabetes. Among the 290 hypertensive
patients，140（48.3%）had adequate hypertension control. Among the 169 diabetics，71（42.0%）had adequate diabetes control.
Among the 130 patients with simple hypertension，those with adequate hypertension control had older mean age than did those without
（t'=3.758，P<0.001）. Among the 160 patients with both hypertension and diabetes，those with adequate hypertension control
had older mean age than did those without（t'=2.203，P=0.031）. Among the 169 patients with diabetes，those with adequate
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control of fasting glycemia had lower rate of regular exercising （χ =4.314，P=0.038）and shorter mean duration of diabetes
（t=-3.180，P=0.002），as well as lower mean frequency of blood glucose monitoring（Z=2.228，P=0.026）than did those without.
Seven themes emerged from the interview：Patients did not feel compelled to reach the targets，feeling indifferent；Patients gave up
after repeated treatments followed by failures to achieve the targets，feeling powerless；Patients took medicines regularly，but had
problems in practical medication；Patients were restricted by various realistic factors；Patients were influenced by doctor-related
factors，including doctors' irrelevant and ignorant attitudes；Patients had failures due to lack of self-control and unhealthy lifestyles；
Other reasons，including unsuccessful medical insurance reimbursement，being afraid of over-control due to previous experiences of
too low blood pressure or glucose，etc. Conclusion The high-risk population of ASCVD who had good disease awareness and took
medications regularly still had low hypertension control rate and/or low glycemic control rate. Attention should be specially given to
blood pressure levels in young hypertensive patients，and glycemic level in diabetic patients with regular exercising，a long history of
diabetes，or frequent blood glucose monitoring. It is necessary to optimize the management of ASCVD in the community by encouraging
patients to improve their mindset and change their unhealthy lifestyles，strengthening the promotion of standardized medication use，
improving community health services，and improving patients' knowledge，beliefs and behaviors from the biopsychosocial perspective.
【Key words】 Atherosclerotic cardiovascular disease；Hypertension；Diabetes mellitus；Control rate；Community
health service center；Quantitative and qualitative study

《中国心血管健康和疾病报告 2019》显示，心血 共卫生服务 ［2］ ，但近期多项研究结果显示，社区高血
管病死亡占城乡居民总死亡原因的首位 ［1］ 。动脉粥样 压 / 糖尿病患者的血压 / 血糖控制情况不容乐观：一项
硬化性心血管疾病（ASCVD）患病人数呈快速增长趋势， 针对山东省 2 型糖尿病社区管理的调查结果显示，实施
将 ASCVD 防控工作“下沉”至社区是大势所趋。重视 管理后，2 型糖尿病患者的血糖控制率为 42.8% ［3］ ；一
ASCVD 高危人群早期筛查，积极控制 ASCVD 的危险因 项针对我国东、中、西部地区社区卫生服务中心在管糖
素，如高血压、糖尿病，是 ASCVD 防控的关键。2009 尿病患者的研究发现，糖尿病患者的空腹血糖控制率为
年以来，我国将高血压、糖尿病管理纳入国家基本公 43.9% ［4］ ；一项针对海口市社区高血压现状的调查研究