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Article(id=1240375108594889661, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308260, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1692115200000, receivedDateStr=2023-08-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658070943, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658070943, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658070943, creator=13701087609, updateTime=1773658070943, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1024, endPage=1031, ext={EN=ArticleExt(id=1240375108796216267, articleId=1240375108594889661, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Systolic blood pressure longitudinal trajectory and its influencing factors in community hypertensive patients during 4 years, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the longitudinal trajectory of systolic blood pressure (SBP) and its influencing factors in community hypertensive patients.

Methods

We used data from national basic public health services for nine counties in Shandong Province to conduct a prospective cohort study. Group-Based Trajectory Modeling (GBTM) was used to explore the trajectory of systolic blood pressure. Repeated measurement analysis of variance was used to describe the changes in trajectories, and multinomial logistic regression was used to explore the influencing factors of the trajectories.

Results

A total of 104 402 hypertension patients were included. The systolic blood pressure trajectories could be divided into four groups: Stage-1 high blood pressure gradually decreased group (21.8%), Stage-1 high blood pressure stable group (55.5%), Stage-2 high blood pressure gradually decreased group (7.2%) and Stage-2 high blood pressure increased group (15.6%). The results of repeated measures analysis of variance showed that there was a significant difference in systolic blood pressure values at different time points or different groups (P<0.001, P<0.001). The results of multinomial logistic regression showed that compared with the group with Stage-1 high blood pressure gradually decreased, the people with less education(OR=82.68, 95% CI:75.60-90.42), physical inactivity(OR=2.77, 95% CI:2.19-3.50), high frequency of drinking(OR=1.39, 95% CI:1.17-1.64), general compliance behavior(OR=1.44, 95% CI:1.18-1.75), intermittent medication(OR=2.15, 95% CI:1.98-2.34) were more likely to be classified into the group with Stage-2 high blood pressure increased. People with increased age (OR=1.03, 95% CI:1.02-1.03), and regular medication (OR=1.94, 95% CI:1.79-2.11) were more likely to be classified into the group with Stage-2 high blood pressure gradually decreased.

Conclusion

The systolic blood pressure trajectories in hypertensive patients can be divided into 4 categories. In the future, we should make more efficient assessments and interventions based on homogeneous populations of systolic blood pressure trajectories and their risk factors.

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目的

探讨社区高血压患者收缩压(SBP)四年间纵向轨迹及其影响因素。

方法

选取符合标准的山东省9个县的国家基本公共卫生服务数据进行前瞻性队列研究。采用组基-轨迹模型识别高血压患者四年收缩压纵向轨迹，采用重复测量方差分析描述各轨迹变化情况，应用无序多分类logistic回归探究各轨迹的影响因素。

结果

共纳入高血压患者104 402名，将高血压患者收缩压纵向轨迹分为4组，即1级高血压逐步下降组(21.8%)、1级高血压水平稳定组(55.5%)、2级高血压逐步下降组(7.2%)、2级高血压水平增长组(15.6%)。重复测量方差分析结果显示，不同时间点、不同组别的收缩压值差异具有显著性(P<0.001，P<0.001)。无序多分类logistic回归结果显示，与1级高血压逐步下降组相比，小学以下的文化程度(OR=82.68, 95% CI：75.60~90.42)、偶尔锻炼(OR=2.77，95% CI：2.19~3.50)、经常饮酒(OR=1.39，95% CI：1.17~1.64)、遵医行为一般(OR=1.44，95% CI：1.18~1.75)、服药依存间断(OR=2.15，95% CI：1.98~2.34)的人更容易归入2级高血压水平增长组；年龄每增长1岁(OR=1.03，95% CI：1.02~1.03)、服药规律(OR=1.94，95% CI：1.79~2.11)更容易归入2级高血压逐步下降组。

结论

高血压患者的收缩压纵向轨迹可以分为4类，其血压变化存在群体异质性，应基于高血压患者收缩压纵向轨迹的同质群体以及其风险因素，更高效地进行评估和干预。

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张高辉，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=a1aasiISAVNhQyeuUS6Ang==, magXml=NiU4o8Cgml5Oz+QaWsh9BQ==, pdfUrl=null, pdf=eN84zbYhlaRuvC3uh2W9DQ==, pdfFileSize=741127, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=aoP8uSFNsguGu3SIS9yNOA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Lk7kl+RPEQw+M+tQ+DucKg==, mapNumber=null, authorCompany=null, fund=null, authors=

董彩云(1998—),女,硕士在读,研究方向：慢性病流行病学

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董彩云(1998—),女,硕士在读,研究方向：慢性病流行病学

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董彩云(1998—),女,硕士在读,研究方向：慢性病流行病学

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The influencing factors of blood pressure control in patients with essential hypertension[J]. Chinese Journal of Public Health Engineering, 2023, 22(2): 214-216, 219., articleTitle=The influencing factors of blood pressure control in patients with essential hypertension, refAbstract=null), Reference(id=1240746313940259284, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, doi=null, pmid=null, pmcid=null, year=2018, volume=45, issue=1, pageStart=62, pageEnd=66, url=null, language=null, rfNumber=[23], rfOrder=33, authorNames=张燕, 杨艳, 雷智, journalName=现代预防医学, refType=null, unstructuredReference=张燕，杨艳，雷智，等．社区高血压患者血压控制情况及影响因素分析[J]．现代预防医学，2018，45（1）：62-66．, articleTitle=社区高血压患者血压控制情况及影响因素分析, refAbstract=null), Reference(id=1240746313994785239, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, doi=null, pmid=null, pmcid=null, year=2018, volume=45, issue=1, pageStart=62, pageEnd=66, url=null, language=null, rfNumber=[23], rfOrder=34, authorNames=Zhang Y, Yang Y, Lei Z, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Zhang Y, Yang Y, Lei Z, et al. Hypertension control and influencing factors in community[J]. Modern Preventive Medicine, 2018, 45(1): 62-66., articleTitle=Hypertension control and influencing factors in community, refAbstract=null)], funds=[Fund(id=1240746310152802595, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, awardId=82273702, language=CN, fundingSource=国家自然科学基金项目(82273702), fundOrder=null, country=null), Fund(id=1240746310270243117, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, awardId=2022HWYQ-030, language=CN, fundingSource=山东省优秀青年学者(海外)科学基金项目(2022HWYQ-030), fundOrder=null, country=null), Fund(id=1240746310379295027, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, awardId=tsqnz20221103, language=CN, fundingSource=泰山学者工程专项基金项目(tsqnz20221103), fundOrder=null, country=null), Fund(id=1240746310484152631, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, awardId=202099000066, language=CN, fundingSource=齐鲁青年学者项目(202099000066), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240746304926700436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, xref=1., ext=[AuthorCompanyExt(id=1240746304947671959, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, companyId=1240746304926700436, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Shandong University, Jinan, Shandong 250012, China), AuthorCompanyExt(id=1240746305052529564, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, companyId=1240746304926700436, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山东大学公共卫生学院流行病学系，山东 济南 250012)]), AuthorCompany(id=1240746305144804259, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, xref=2., ext=[AuthorCompanyExt(id=1240746305153192868, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, companyId=1240746305144804259, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.山东省疾病预防控制中心健康管理所)])], figs=[ArticleFig(id=1240746308642853065, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=EN, label=Fig.1, caption=Different SBP trajectory groups of community hypertensive patients, figureFileSmall=/Dv1JEWSZZ6/PDXNx4kcBg==, figureFileBig=pa5/7c4blSnitpXumtC6kA==, tableContent=null), ArticleFig(id=1240746308739322066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=CN, label=图1, caption=高血压患者收缩压纵向轨迹图, figureFileSmall=/Dv1JEWSZZ6/PDXNx4kcBg==, figureFileBig=pa5/7c4blSnitpXumtC6kA==, tableContent=null), ArticleFig(id=1240746308856762584, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=EN, label=Table 1, caption=

Relevant parameters in the process of fitting systolic pressure trajectory model

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组数各组阶数BICAIC各组概率 (%)
组1组2组3组4组5
23 3-1 927 755-1 927 70050.0050.00
33 3 3-1 925 988-1 925 90633.3333.3333.33
43 3 3 3-1 925 283-1 925 17325.0025.0025.0025.00
53 3 3 3 3-1 924 949-1 924 81320.0020.0020.0020.0020.00
41 1 1 2-1 905 233-1 905 16221.8055.5015.607.20
), ArticleFig(id=1240746308944842972, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=CN, label=表1, caption=

收缩压轨迹模型拟合过程中的相关参数

, figureFileSmall=null, figureFileBig=null, tableContent=
组数各组阶数BICAIC各组概率 (%)
组1组2组3组4组5
23 3-1 927 755-1 927 70050.0050.00
33 3 3-1 925 988-1 925 90633.3333.3333.33
43 3 3 3-1 925 283-1 925 17325.0025.0025.0025.00
53 3 3 3 3-1 924 949-1 924 81320.0020.0020.0020.0020.00
41 1 1 2-1 905 233-1 905 16221.8055.5015.607.20
), ArticleFig(id=1240746309041311970, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=EN, label=Table 2, caption=

Model evaluation of systolic blood pressure trajectory

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ClassAvePP
Class 10.74
Class 20.81
Class 30.83
Class 40.74
), ArticleFig(id=1240746309150363880, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=CN, label=表2, caption=

收缩压轨迹的模型评价

, figureFileSmall=null, figureFileBig=null, tableContent=
ClassAvePP
Class 10.74
Class 20.81
Class 30.83
Class 40.74
), ArticleFig(id=1240746309259415791, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=EN, label=Table 3, caption=

The results of repeated measurement analysis of variance

, figureFileSmall=null, figureFileBig=null, tableContent=
源SSdfMSFP
时间38 563 181.223312 854 393.74144 895.575<0.001
分组67 977 653.648322 659 217.88367 919.113<0.001
时间*分组52 497 082.55395 833 009.17320 372.513<0.001
), ArticleFig(id=1240746309330718966, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=CN, label=表3, caption=

重复测量方差分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
源SSdfMSFP
时间38 563 181.223312 854 393.74144 895.575<0.001
分组67 977 653.648322 659 217.88367 919.113<0.001
时间*分组52 497 082.55395 833 009.17320 372.513<0.001
), ArticleFig(id=1240746309506879740, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=EN, label=Table 4, caption=

Comparison of baseline data of different systolic blood pressure trajectories groups

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人群
(n=104 402)		1级高血压逐步下降组
(n=19 175)		1级高血压水平稳定组
(n=63 484)		2级高血压水平增长组
(n =15 012)		2级高血压逐步下降组
(n=6 731)		P值
性别[n(%)]<0.001
男42 297(40.5)7 685(40.1)26 537(41.8)5 779(38.5)2 296(34.1)
女62 105(59.5)11 490(59.9)36 947(58.2)9 233(61.5)4 435(65.9)
年龄（岁）()73.09±7.4374.43±6.5672.11±7.8774.31±6.2775.88±6.08<0.001
血型[n(%)]<0.001
A型32 055(31.1)5 964(31.1)19 564(30.8)4 473(29.8)2 054(30.5)
B型32 487(30.7)5 879(30.7)19 778(31.2)4 710(31.3)2 120(31.5)
O型28 694(26.7)5 123(26.7)17 545(27.6)4 297(28.7)1 729(25.7)
AB型11 166(11.5)2 209(11.5)6 597(10.4)1 532(10.2)828(12.3)
教育程度[n(%)]<0.001
小学及以下60 178(57.7)2 948(15.4)42 547(67.0)13 759(91.6)924(13.8)
初中3 680(3.5)844(4.4)2 300(3.6)341(2.3)195(2.9)
高中/中专9 864(9.5)2 917(15.2)5 934(9.4)192(1.3)821(12.2)
大专及以上30 680(29.3)12 466(65.0)12 703(20.0)720(4.8)4 791(71.1)
婚姻状况[n(%)]<0.001
未婚1 553(1.5)121(0.6)1 071(1.7)299(2.0)62(0.9)
已婚81 457(78.0)15 991(83.4)49 311(77.6)10 809(72.0)5 346(79.5)
丧偶21 194(20.3)3 031(15.8)12 972(20.5)3 876(25.8)1 315(19.5)
离婚198(0.2)32(0.2)130(0.2)28(0.2)8(0.1)
心率（次/min)()72.05±11.9972.55±12.4471.53±11.4972.45±12.5674.59±13.55<0.001
呼吸频率（次/min)()18.12±2.9118.29±1.9918.08±3.2017.97±2.9418.36±1.98<0.001
腰围（cm）()86.13±9.5486.73±9.0685.72±9.5586.23±9.9188.07±9.62<0.001
体重指数[n(%)]<0.001
体重过轻2 095(2.0)315(1.7)1 398(2.2)312(2.1)70(1.1)
正常体重38 425(37.2)6 331(33.5)24 520(39.1)5 764(38.8)1 810(27.3)
超重41 365(40.1)8 137(43.0)24 597(39.1)5 763(38.7)2 868(43.2)
肥胖21 383(20.7)4 138(21.8)12 328(19.6)3 030(20.4)1 887(28.4)
锻炼频率[n(%)]<0.001
每天18 595(17.8)4 423(23.0)10 104(15.9)2 603(17.3)1 465(21.7)
每周一次及以上7 825(7.5)1 416(7.4)5 079(8.1)917(6.1)413(6.1)
偶尔2 377(2.3)110(0.6)1 860(2.9)364(2.4)43(0.7)
不锻炼75 605(72.4)13 226(69.0)46 441(73.1)11 128(74.2)4 810(71.5)
吸烟状况[n(%)]<0.001
从不吸烟84 481(80.9)16 465(85.9)50 081(78.9)12 008(79.9)5 927(88.1)
已戒烟4 149(4.0)336(1.7)2 950(4.7)765(5.2)98(1.5)
吸烟15 772(15.1)2 374(12.4)10 453(16.4)2 239(14.9)706(10.4)
饮酒频率[n(%)]<0.001
从不83 449(79.9)16 383(85.4)49 852(78.5)11 543(76.8)5 671(84.4)
偶尔5 530(5.3)638(3.3)3 805(6.0)940(6.3)147(2.2)
经常3 592(3.5)324(1.7)2 613(4.1)567(3.8)88(1.3)
每天11 831(11.3)1 830(9.6)7 214(11.4)1 962(13.1)825(12.1)
摄盐情况[n(%)]<0.001
轻39 591(37.9)7 086(37.0)23 077(36.3)6 845(45.7)2 583(38.3)
中60 691(58.1)11 536(60.1)37 718(59.4)7 493(49.8)3 944(58.6)
重4 120(4.0)553(2.9)2 689(4.3)674(4.5)204(3.1)
心理调整[n(%)]<0.001
良好83 846(80.3)16 986(88.6)49 936(78.7)11 049(73.6)5 875(87.2)
一般20 120(19.3)2 166(11.3)13 241(20.8)3 868(25.8)845(12.6)
差436(0.4)23(0.1)307(0.5)95(0.6)11(0.2)
遵医行为[n(%)]<0.001
良好71 499(68.5)16 127(84.1)41 276(65.0)8 594(57.2)5 502(81.6)
一般30 405(29.1)2 832(14.8)20 503(32.3)5 924(39.5)1 146(17.2)
差2 498(2.4)216(1.1)1 705(2.7)494(3.3)83(1.2)
服药依存性[n(%)]<0.001
规律59 813(57.3)12 623(65.8)34 044(53.6)8 156(54.3)4 990(74.1)
间断22 252(21.3)2 106(11.0)14 991(23.6)4 301(28.6)854(12.7)
不服药22 337(21.4)4 446(23.2)14 449(22.8)2 555(17.1)887(13.2)
), ArticleFig(id=1240746309628514562, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=CN, label=表4, caption=

各收缩压纵向轨迹组人群的基线特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人群
(n=104 402)		1级高血压逐步下降组
(n=19 175)		1级高血压水平稳定组
(n=63 484)		2级高血压水平增长组
(n =15 012)		2级高血压逐步下降组
(n=6 731)		P值
性别[n(%)]<0.001
男42 297(40.5)7 685(40.1)26 537(41.8)5 779(38.5)2 296(34.1)
女62 105(59.5)11 490(59.9)36 947(58.2)9 233(61.5)4 435(65.9)
年龄（岁）()73.09±7.4374.43±6.5672.11±7.8774.31±6.2775.88±6.08<0.001
血型[n(%)]<0.001
A型32 055(31.1)5 964(31.1)19 564(30.8)4 473(29.8)2 054(30.5)
B型32 487(30.7)5 879(30.7)19 778(31.2)4 710(31.3)2 120(31.5)
O型28 694(26.7)5 123(26.7)17 545(27.6)4 297(28.7)1 729(25.7)
AB型11 166(11.5)2 209(11.5)6 597(10.4)1 532(10.2)828(12.3)
教育程度[n(%)]<0.001
小学及以下60 178(57.7)2 948(15.4)42 547(67.0)13 759(91.6)924(13.8)
初中3 680(3.5)844(4.4)2 300(3.6)341(2.3)195(2.9)
高中/中专9 864(9.5)2 917(15.2)5 934(9.4)192(1.3)821(12.2)
大专及以上30 680(29.3)12 466(65.0)12 703(20.0)720(4.8)4 791(71.1)
婚姻状况[n(%)]<0.001
未婚1 553(1.5)121(0.6)1 071(1.7)299(2.0)62(0.9)
已婚81 457(78.0)15 991(83.4)49 311(77.6)10 809(72.0)5 346(79.5)
丧偶21 194(20.3)3 031(15.8)12 972(20.5)3 876(25.8)1 315(19.5)
离婚198(0.2)32(0.2)130(0.2)28(0.2)8(0.1)
心率（次/min)()72.05±11.9972.55±12.4471.53±11.4972.45±12.5674.59±13.55<0.001
呼吸频率（次/min)()18.12±2.9118.29±1.9918.08±3.2017.97±2.9418.36±1.98<0.001
腰围（cm）()86.13±9.5486.73±9.0685.72±9.5586.23±9.9188.07±9.62<0.001
体重指数[n(%)]<0.001
体重过轻2 095(2.0)315(1.7)1 398(2.2)312(2.1)70(1.1)
正常体重38 425(37.2)6 331(33.5)24 520(39.1)5 764(38.8)1 810(27.3)
超重41 365(40.1)8 137(43.0)24 597(39.1)5 763(38.7)2 868(43.2)
肥胖21 383(20.7)4 138(21.8)12 328(19.6)3 030(20.4)1 887(28.4)
锻炼频率[n(%)]<0.001
每天18 595(17.8)4 423(23.0)10 104(15.9)2 603(17.3)1 465(21.7)
每周一次及以上7 825(7.5)1 416(7.4)5 079(8.1)917(6.1)413(6.1)
偶尔2 377(2.3)110(0.6)1 860(2.9)364(2.4)43(0.7)
不锻炼75 605(72.4)13 226(69.0)46 441(73.1)11 128(74.2)4 810(71.5)
吸烟状况[n(%)]<0.001
从不吸烟84 481(80.9)16 465(85.9)50 081(78.9)12 008(79.9)5 927(88.1)
已戒烟4 149(4.0)336(1.7)2 950(4.7)765(5.2)98(1.5)
吸烟15 772(15.1)2 374(12.4)10 453(16.4)2 239(14.9)706(10.4)
饮酒频率[n(%)]<0.001
从不83 449(79.9)16 383(85.4)49 852(78.5)11 543(76.8)5 671(84.4)
偶尔5 530(5.3)638(3.3)3 805(6.0)940(6.3)147(2.2)
经常3 592(3.5)324(1.7)2 613(4.1)567(3.8)88(1.3)
每天11 831(11.3)1 830(9.6)7 214(11.4)1 962(13.1)825(12.1)
摄盐情况[n(%)]<0.001
轻39 591(37.9)7 086(37.0)23 077(36.3)6 845(45.7)2 583(38.3)
中60 691(58.1)11 536(60.1)37 718(59.4)7 493(49.8)3 944(58.6)
重4 120(4.0)553(2.9)2 689(4.3)674(4.5)204(3.1)
心理调整[n(%)]<0.001
良好83 846(80.3)16 986(88.6)49 936(78.7)11 049(73.6)5 875(87.2)
一般20 120(19.3)2 166(11.3)13 241(20.8)3 868(25.8)845(12.6)
差436(0.4)23(0.1)307(0.5)95(0.6)11(0.2)
遵医行为[n(%)]<0.001
良好71 499(68.5)16 127(84.1)41 276(65.0)8 594(57.2)5 502(81.6)
一般30 405(29.1)2 832(14.8)20 503(32.3)5 924(39.5)1 146(17.2)
差2 498(2.4)216(1.1)1 705(2.7)494(3.3)83(1.2)
服药依存性[n(%)]<0.001
规律59 813(57.3)12 623(65.8)34 044(53.6)8 156(54.3)4 990(74.1)
间断22 252(21.3)2 106(11.0)14 991(23.6)4 301(28.6)854(12.7)
不服药22 337(21.4)4 446(23.2)14 449(22.8)2 555(17.1)887(13.2)
), ArticleFig(id=1240746309758537995, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=EN, label=Table 5, caption=

Influencing factors of systolic blood pressure trajectory in hypertensive patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量1级高血压水平稳定组
(对照=1级高血压逐步下降组)		2级高血压水平增长组
(对照=1级高血压逐步下降组)
偏回归系数OR(95% CI)P值偏回归系数OR(95% CI)P值
性别(对照组=女性)
男性-0.1230.88(0.84~0.93)<0.001-0.2850.75(0.71~0.80)<0.001
年龄-0.0560.95(0.94~0.95)<0.001-0.0210.98(0.98~0.98)<0.001
血型(对照组=AB型)
A型-0.0280.97(0.91~1.04)0.405-0.1340.87(0.80~0.95)0.003
B型-0.0050.99(0.93~1.06)0.877-0.0690.93(0.85~1.02)0.123
O型0.0101.01(0.95~1.08)0.759-0.0240.98(0.89~1.07)0.594
教育程度(对照组=大专及以上)
小学及以下2.73715.44(14.68~16.24)<0.0014.41582.68(75.60~90.42)<0.001
初中0.9022.46(2.25~2.70)<0.0012.0057.43(6.38~8.65)<0.001
高中/中专0.2931.34(1.27~1.42)<0.0010.0171.02(0.86~1.20)0.845
婚姻状况(对照组=离婚)
未婚0.2421.27(0.78~2.08)0.3350.4161.52(0.81~2.85)0.195
已婚-0.0130.99(0.63~1.54)0.9550.0321.03(0.58~1.85)0.914
丧偶0.2481.28(0.82~2.01)0.2790.2261.25(0.70~2.26)0.452
心率，每分钟-0.0050.99(0.99~1.00)<0.0010.0021.00(1.00~1.00) 0.132
呼吸频率，每分钟-0.0090.99(0.98~1.00)0.011-0.0160.98(0.98~0.99)<0.001
腰围，厘米-0.0021.00(1.00~1.00)0.1150.0091.01(1.01~1.01)<0.001
体重指数(对照组=肥胖)
体重过轻0.0071.01(0.86~1.18)0.933-0.2310.79(0.65~0.97)0.026
正常体重0.0431.04(0.98~1.11)0.2010.0031.00(0.92~1.09)0.953
超重-0.0510.95(0.90~1.00)0.066-0.0410.96(0.89~1.03)0.269
锻炼频率(对照组=不锻炼)
每天-0.7210.49(0.46~0.51)<0.001-0.8560.42(0.40~0.45)<0.001
每周一次及以上0.2441.28(1.19~1.37)<0.0010.0631.06(0.96~1.18)0.216
偶尔1.3463.84(3.12~4.73)<0.0011.0192.77(2.19~3.50)<0.001
吸烟状况(对照组=吸烟)
从不吸烟-0.0930.91(0.85~0.97)0.0060.0931.10(1.01~1.20)0.036
已戒烟0.3371.40(1.22~1.61)<0.0010.3261.39(1.18~1.63)<0.001
饮酒频率(对照组=每天)
从不-0.1520.86(0.80~0.93)<0.001-0.5660.57(0.52~0.63)<0.001
偶尔0.0441.04(0.93~1.17)0.454-0.2160.81(0.70~0.93)0.002
经常0.4811.62(1.41~1.86)<0.0010.3281.39(1.17~1.64)<0.001
摄盐情况(对照组=重)
轻-0.4970.61(0.54~0.68)<0.001-0.4070.67(0.58~0.76)<0.001
中-0.0600.94(0.85~1.05)0.280-0.1690.84(0.74~0.97)0.014
心理调整(对照组=差)
良好-0.1620.85(0.53~1.36)0.503-0.0940.91(0.55~1.52)0.720
一般-0.6160.54(0.34~0.87)0.011-0.5360.58(0.35~0.98)0.041
遵医行为(对照组=差)
良好-0.0800.92(0.78~1.09)0.357-0.2660.77(0.63~0.93)0.008
一般0.4271.53(1.29~1.82)<0.0010.3641.44(1.18~1.75)<0.001
服药依存性(对照组=不服药)
规律-0.1650.85(0.81~0.89)<0.0010.1181.12(1.05~1.20)0.001
间断0.4141.51(1.42~1.61)<0.0010.7652.15(1.98~2.34)<0.001
变量2级高血压逐步下降组
(对照=1级高血压逐步下降组)
偏回归系数OR(95% CI)P值
性别(对照组=女性)
男性-0.2910.75(0.69~0.81)<0.001
年龄0.0271.03(1.02~1.03)<0.001
血型(对照组=AB型)
A型-0.0920.91(0.83~1.00)0.062
B型-0.0440.96(0.87~1.05)0.372
O型-0.1070.90(0.81~0.99)0.034
教育程度(对照组=大专及以上)
小学及以下-0.2240.80(0.73~0.87)<0.001
初中-0.3680.69(0.59~0.82)<0.001
高中/中专-0.1090.90(0.82~0.98)0.017
婚姻状况(对照组=离婚)
未婚0.9242.52(1.08~5.86)0.032
已婚0.2371.27(0.58~2.78)0.554
丧偶0.2961.34(0.61~2.96)0.462
心率，每分钟0.0101.01(1.01~1.01)<0.001
呼吸频率，每分钟0.0031.00(0.99~1.01)0.532
腰围，厘米0.0081.01(1.00~1.01)<0.001
体重指数(对照组=肥胖)
体重过轻-0.6180.54(0.41~0.71)<0.001
正常体重-0.3340.72(0.65~0.79)<0.001
超重-0.1710.84(0.78~0.91)<0.001
锻炼频率(对照组=不锻炼)
每天-0.0840.92(0.86~0.99)0.020
每周一次及以上-0.2200.80(0.71~0.90)<0.001
偶尔0.1561.17(0.82~1.67)0.392
吸烟状况(对照组=吸烟)
从不吸烟0.1401.15(1.03~1.28)0.011
已戒烟0.0091.01(0.79~1.29)0.941
饮酒频率(对照组=每天)
从不-0.6820.51(0.45~0.56)<0.001
偶尔-0.7250.48(0.40~0.59)<0.001
经常-0.4900.61(0.48~0.79)<0.001
摄盐情况(对照组=重)
轻-0.0250.98(0.82~1.16)0.777
中-0.0770.93(0.78~1.09)0.368
心理调整(对照组=差)
良好-0.2040.82(0.38~1.74)0.596
一般-0.2780.76(0.36~1.62)0.472
遵医行为(对照组=差)
良好-0.5370.58(0.44~0.77)<0.001
一般-0.2450.78(0.59~1.04)0.090
服药依存性(对照组=不服药)
规律0.6641.94(1.79~2.11)<0.001
间断0.6821.98(1.77~2.21)<0.001
), ArticleFig(id=1240746309875978514, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375108594889661, language=CN, label=表5, caption=

高血压患者收缩压轨迹的影响因素

, figureFileSmall=null, figureFileBig=null, tableContent=
变量1级高血压水平稳定组
(对照=1级高血压逐步下降组)		2级高血压水平增长组
(对照=1级高血压逐步下降组)
偏回归系数OR(95% CI)P值偏回归系数OR(95% CI)P值
性别(对照组=女性)
男性-0.1230.88(0.84~0.93)<0.001-0.2850.75(0.71~0.80)<0.001
年龄-0.0560.95(0.94~0.95)<0.001-0.0210.98(0.98~0.98)<0.001
血型(对照组=AB型)
A型-0.0280.97(0.91~1.04)0.405-0.1340.87(0.80~0.95)0.003
B型-0.0050.99(0.93~1.06)0.877-0.0690.93(0.85~1.02)0.123
O型0.0101.01(0.95~1.08)0.759-0.0240.98(0.89~1.07)0.594
教育程度(对照组=大专及以上)
小学及以下2.73715.44(14.68~16.24)<0.0014.41582.68(75.60~90.42)<0.001
初中0.9022.46(2.25~2.70)<0.0012.0057.43(6.38~8.65)<0.001
高中/中专0.2931.34(1.27~1.42)<0.0010.0171.02(0.86~1.20)0.845
婚姻状况(对照组=离婚)
未婚0.2421.27(0.78~2.08)0.3350.4161.52(0.81~2.85)0.195
已婚-0.0130.99(0.63~1.54)0.9550.0321.03(0.58~1.85)0.914
丧偶0.2481.28(0.82~2.01)0.2790.2261.25(0.70~2.26)0.452
心率，每分钟-0.0050.99(0.99~1.00)<0.0010.0021.00(1.00~1.00) 0.132
呼吸频率，每分钟-0.0090.99(0.98~1.00)0.011-0.0160.98(0.98~0.99)<0.001
腰围，厘米-0.0021.00(1.00~1.00)0.1150.0091.01(1.01~1.01)<0.001
体重指数(对照组=肥胖)
体重过轻0.0071.01(0.86~1.18)0.933-0.2310.79(0.65~0.97)0.026
正常体重0.0431.04(0.98~1.11)0.2010.0031.00(0.92~1.09)0.953
超重-0.0510.95(0.90~1.00)0.066-0.0410.96(0.89~1.03)0.269
锻炼频率(对照组=不锻炼)
每天-0.7210.49(0.46~0.51)<0.001-0.8560.42(0.40~0.45)<0.001
每周一次及以上0.2441.28(1.19~1.37)<0.0010.0631.06(0.96~1.18)0.216
偶尔1.3463.84(3.12~4.73)<0.0011.0192.77(2.19~3.50)<0.001
吸烟状况(对照组=吸烟)
从不吸烟-0.0930.91(0.85~0.97)0.0060.0931.10(1.01~1.20)0.036
已戒烟0.3371.40(1.22~1.61)<0.0010.3261.39(1.18~1.63)<0.001
饮酒频率(对照组=每天)
从不-0.1520.86(0.80~0.93)<0.001-0.5660.57(0.52~0.63)<0.001
偶尔0.0441.04(0.93~1.17)0.454-0.2160.81(0.70~0.93)0.002
经常0.4811.62(1.41~1.86)<0.0010.3281.39(1.17~1.64)<0.001
摄盐情况(对照组=重)
轻-0.4970.61(0.54~0.68)<0.001-0.4070.67(0.58~0.76)<0.001
中-0.0600.94(0.85~1.05)0.280-0.1690.84(0.74~0.97)0.014
心理调整(对照组=差)
良好-0.1620.85(0.53~1.36)0.503-0.0940.91(0.55~1.52)0.720
一般-0.6160.54(0.34~0.87)0.011-0.5360.58(0.35~0.98)0.041
遵医行为(对照组=差)
良好-0.0800.92(0.78~1.09)0.357-0.2660.77(0.63~0.93)0.008
一般0.4271.53(1.29~1.82)<0.0010.3641.44(1.18~1.75)<0.001
服药依存性(对照组=不服药)
规律-0.1650.85(0.81~0.89)<0.0010.1181.12(1.05~1.20)0.001
间断0.4141.51(1.42~1.61)<0.0010.7652.15(1.98~2.34)<0.001
变量2级高血压逐步下降组
(对照=1级高血压逐步下降组)
偏回归系数OR(95% CI)P值
性别(对照组=女性)
男性-0.2910.75(0.69~0.81)<0.001
年龄0.0271.03(1.02~1.03)<0.001
血型(对照组=AB型)
A型-0.0920.91(0.83~1.00)0.062
B型-0.0440.96(0.87~1.05)0.372
O型-0.1070.90(0.81~0.99)0.034
教育程度(对照组=大专及以上)
小学及以下-0.2240.80(0.73~0.87)<0.001
初中-0.3680.69(0.59~0.82)<0.001
高中/中专-0.1090.90(0.82~0.98)0.017
婚姻状况(对照组=离婚)
未婚0.9242.52(1.08~5.86)0.032
已婚0.2371.27(0.58~2.78)0.554
丧偶0.2961.34(0.61~2.96)0.462
心率，每分钟0.0101.01(1.01~1.01)<0.001
呼吸频率，每分钟0.0031.00(0.99~1.01)0.532
腰围，厘米0.0081.01(1.00~1.01)<0.001
体重指数(对照组=肥胖)
体重过轻-0.6180.54(0.41~0.71)<0.001
正常体重-0.3340.72(0.65~0.79)<0.001
超重-0.1710.84(0.78~0.91)<0.001
锻炼频率(对照组=不锻炼)
每天-0.0840.92(0.86~0.99)0.020
每周一次及以上-0.2200.80(0.71~0.90)<0.001
偶尔0.1561.17(0.82~1.67)0.392
吸烟状况(对照组=吸烟)
从不吸烟0.1401.15(1.03~1.28)0.011
已戒烟0.0091.01(0.79~1.29)0.941
饮酒频率(对照组=每天)
从不-0.6820.51(0.45~0.56)<0.001
偶尔-0.7250.48(0.40~0.59)<0.001
经常-0.4900.61(0.48~0.79)<0.001
摄盐情况(对照组=重)
轻-0.0250.98(0.82~1.16)0.777
中-0.0770.93(0.78~1.09)0.368
心理调整(对照组=差)
良好-0.2040.82(0.38~1.74)0.596
一般-0.2780.76(0.36~1.62)0.472
遵医行为(对照组=差)
良好-0.5370.58(0.44~0.77)<0.001
一般-0.2450.78(0.59~1.04)0.090
服药依存性(对照组=不服药)
规律0.6641.94(1.79~2.11)<0.001
间断0.6821.98(1.77~2.21)<0.001
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社区高血压患者四年间收缩压纵向轨迹及其影响因素研究
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董彩云 1 , 孙惠子 1 , 齐聪 2 , 陈良侠 2 , 朱东山 1 , 张高辉 2
现代预防医学 | 基层卫生服务 2024,51(6): 1024-1031
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现代预防医学 | 基层卫生服务 2024, 51(6): 1024-1031
社区高血压患者四年间收缩压纵向轨迹及其影响因素研究
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董彩云1, 孙惠子1, 齐聪2, 陈良侠2, 朱东山1, 张高辉2
作者信息
  • 1.山东大学公共卫生学院流行病学系，山东 济南 250012
  • 2.山东省疾病预防控制中心健康管理所

    • 董彩云(1998—),女,硕士在读,研究方向：慢性病流行病学

通讯作者:

张高辉，E-mail：
Systolic blood pressure longitudinal trajectory and its influencing factors in community hypertensive patients during 4 years
Cai-yun DONG1, Hui-zi SUN1, Cong QI2, Liang-xia CHEN2, Dong-shan ZHU1, Gao-hui ZHANG2
Affiliations
  • School of Public Health, Shandong University, Jinan, Shandong 250012, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202308260
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摘要
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目的

探讨社区高血压患者收缩压(SBP)四年间纵向轨迹及其影响因素。

方法

选取符合标准的山东省9个县的国家基本公共卫生服务数据进行前瞻性队列研究。采用组基-轨迹模型识别高血压患者四年收缩压纵向轨迹，采用重复测量方差分析描述各轨迹变化情况，应用无序多分类logistic回归探究各轨迹的影响因素。

结果

共纳入高血压患者104 402名，将高血压患者收缩压纵向轨迹分为4组，即1级高血压逐步下降组(21.8%)、1级高血压水平稳定组(55.5%)、2级高血压逐步下降组(7.2%)、2级高血压水平增长组(15.6%)。重复测量方差分析结果显示，不同时间点、不同组别的收缩压值差异具有显著性(P<0.001，P<0.001)。无序多分类logistic回归结果显示，与1级高血压逐步下降组相比，小学以下的文化程度(OR=82.68, 95% CI：75.60~90.42)、偶尔锻炼(OR=2.77，95% CI：2.19~3.50)、经常饮酒(OR=1.39，95% CI：1.17~1.64)、遵医行为一般(OR=1.44，95% CI：1.18~1.75)、服药依存间断(OR=2.15，95% CI：1.98~2.34)的人更容易归入2级高血压水平增长组；年龄每增长1岁(OR=1.03，95% CI：1.02~1.03)、服药规律(OR=1.94，95% CI：1.79~2.11)更容易归入2级高血压逐步下降组。

结论

高血压患者的收缩压纵向轨迹可以分为4类，其血压变化存在群体异质性，应基于高血压患者收缩压纵向轨迹的同质群体以及其风险因素，更高效地进行评估和干预。

高血压患者  /  血压控制  /  影响因素  /  纵向数据  /  组基-轨迹模型
Objective

To explore the longitudinal trajectory of systolic blood pressure (SBP) and its influencing factors in community hypertensive patients.

Methods

We used data from national basic public health services for nine counties in Shandong Province to conduct a prospective cohort study. Group-Based Trajectory Modeling (GBTM) was used to explore the trajectory of systolic blood pressure. Repeated measurement analysis of variance was used to describe the changes in trajectories, and multinomial logistic regression was used to explore the influencing factors of the trajectories.

Results

A total of 104 402 hypertension patients were included. The systolic blood pressure trajectories could be divided into four groups: Stage-1 high blood pressure gradually decreased group (21.8%), Stage-1 high blood pressure stable group (55.5%), Stage-2 high blood pressure gradually decreased group (7.2%) and Stage-2 high blood pressure increased group (15.6%). The results of repeated measures analysis of variance showed that there was a significant difference in systolic blood pressure values at different time points or different groups (P<0.001, P<0.001). The results of multinomial logistic regression showed that compared with the group with Stage-1 high blood pressure gradually decreased, the people with less education(OR=82.68, 95% CI:75.60-90.42), physical inactivity(OR=2.77, 95% CI:2.19-3.50), high frequency of drinking(OR=1.39, 95% CI:1.17-1.64), general compliance behavior(OR=1.44, 95% CI:1.18-1.75), intermittent medication(OR=2.15, 95% CI:1.98-2.34) were more likely to be classified into the group with Stage-2 high blood pressure increased. People with increased age (OR=1.03, 95% CI:1.02-1.03), and regular medication (OR=1.94, 95% CI:1.79-2.11) were more likely to be classified into the group with Stage-2 high blood pressure gradually decreased.

Conclusion

The systolic blood pressure trajectories in hypertensive patients can be divided into 4 categories. In the future, we should make more efficient assessments and interventions based on homogeneous populations of systolic blood pressure trajectories and their risk factors.

Hypertensive patients  /  Blood pressure control  /  Risk factors  /  Longitudinal study  /  Group-based trajectory model
董彩云, 孙惠子, 齐聪, 陈良侠, 朱东山, 张高辉. 社区高血压患者四年间收缩压纵向轨迹及其影响因素研究. 现代预防医学, 2024 , 51 (6) : 1024 -1031 . DOI: 10.20043/j.cnki.MPM.202308260
Cai-yun DONG, Hui-zi SUN, Cong QI, Liang-xia CHEN, Dong-shan ZHU, Gao-hui ZHANG. Systolic blood pressure longitudinal trajectory and its influencing factors in community hypertensive patients during 4 years[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1024 -1031 . DOI: 10.20043/j.cnki.MPM.202308260
正文
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据中国高血压防治指南报告，我国人群高血压的患病率仍呈升高趋势[1]。同时我国18岁以上人群的高血压控制率也有了明显提高，从2012的13.8%到2015年的16.8%[1-2]。但近年来自海德堡大学医学院的一项关于中等收入国家的高血压管理研究报告中国的血压控制率只有9%[3]。高血压是罹患脑卒中、心肌梗死乃至造成心血管死亡的首要危险因素[4]。有效控制血压是降低患者心脑血管疾病发病率、延长寿命、提高生命质量的一种最有效措施[5]。
前瞻性的队列研究发现，血压轨迹内部存在异质性[6-8]。但是，这些血压纵向轨迹的研究人群大多针对青少年或者中老年人的健康人群，针对于高血压患者的血压纵向轨迹研究还处于空白[9-10]。而高血压患者是一个独特的群体，其血压纵向轨迹及影响因素与其他人群不同。其次，目前关于血压控制的研究，大多是通过计算横断面控制率或按高血压标准将高血压患者分为血压控制达标组和未达标组，再进行影响因素的分析[11-12]，而基于血压纵向轨迹研究血压控制的影响因素仍处于空白。
本研究以社区高血压患者为研究对象，研究其血压纵向轨迹，通过其血压纵向轨迹来反映血压控制情况，并寻找其影响因素，为基层公共卫生实践、高血压患者健康随访等提供建议。
1 对象和方法
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1.1 研究对象
本研究采用分层整群随机抽样方法，从山东省东（鲁东4个市）、中（鲁中2个市）、西（鲁西3个市）分别抽取若干市，从每市随机抽取一个县(潍坊市安丘市、济南市钢城区、济宁市邹城市、东营市垦利市、德州市陵城区、泰安市宁阳县、青岛市城阳区、潍坊市寿光市、淄博市沂源县)，利用该县国家基本公共卫生服务数据开展研究。依据中国高血压防治指南（2018年修订版）的血压诊断标准，通过相关医疗机构、社区等医疗人员对辖区内35岁及以上常住居民每年进行免费测量血压，对第一次发现收缩压≥140 mmHg和（或）舒张压≥ 90 mmHg的居民在去除可能引起血压升高的因素后预约其复查，非同日3次测量血压高于正常，可初步诊断为高血压[1]。对已确诊的原发性高血压患者纳入高血压患者健康管理。将国家基本公共卫生服务数据库中的健康体检数据库与高血压患者健康管理数据库按个人健康编码建立连接。人群纳入标准：(1)辖区内35岁以上原发性高血压患者；(2)2018年、2019年、2020年、2021年健康体检资料中有收缩压值的完整记录。将缺失条目过多或者有异常值的数据(14 020人)剔除后，共纳入104 402人。
1.2 研究变量
(1)血压：受试者静坐休息10分钟后，由受过培训的卫生工作者或护士使用校准的水银柱血压计或电子血压计遵循标准化程序，测量其双上臂舒张压与收缩压。当左上肢血压与右上肢血压不等时，选其高值作为收缩压值。选取2018年、2019年、2020年、2021年健康体检数据库中的收缩压测量值作为4个时间节点的收缩压值。(2)暴露因素：暴露因素的选取囊括了个人基本信息、身体指标、生活方式、服药依从等维度，其中性别、年龄、血型、教育程度、婚姻状况、呼吸频率、腰围、心率、体质指数、锻炼频率、吸烟状况、饮酒频率变量是从健康体检数据库(2018年)获取；摄盐情况、心理调整、遵医行为、服药依从性变量是从高血压患者健康管理数据库(2018年)获取。暴露变量中性别、教育程度、婚姻状况、锻炼频率、吸烟状况、饮酒频率变量通过居民自我报告获取；血型、呼吸频率、腰围、心率、体质指数变量通过医生检查获取。体育锻炼，指主动锻炼，即有意识地为强身健体而进行的活动，不包括因工作或其他需要而进行的其他活动，如上班骑自行车、做强体力工作等；心理调整是根据医生印象选择对应的选项；遵医行为是指患者是否遵照医生的指导去改善生活方式；服药依存性“规律”为按医生医嘱服药，“间断”为未按医生医嘱服药，频次或数量不足，“不服药”即为医生开了处方，但患者未使用此药。医生可以来自随访机构，也可来自其他医疗机构。
1.3 统计方法
使用SAS 9.4软件进行分析，轨迹模型通过SAS Proc Traj程序完成[13-14]。用均数±标准差()表示连续性变量，构成比表示分类变量，并使用方差分析、χ2检验进行组间比较。以收缩压值作为因变量，以4个时间节点(2018年、2019年、2020年、2021年)为自变量构建组基-轨迹模型。采用重复测量方差分析描述各轨迹变化情况。为探究各轨迹组的影响因素，以轨迹组为因变量，性别、年龄、血型、教育程度等为自变量，做无序多分类logistic回归，检验水准α＝0.05。模型评判标准包括主观标准和假设检验、分类标准、信息标准等多种客观标准[15-16]，常用的是基于对数似然函数的贝叶斯信息准则(Bayesian Information Criterion, BIC)。
2 结果
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2.1 高血压患者收缩压纵向轨迹
拟合轨迹过程中的相关参数如表1所示。当高血压患者收缩压纵向轨迹的多项式阶数保持恒定为3时，随着轨迹组数由2~5逐渐递增时，BIC的绝对值逐渐减小，组数为5时达到最小。由于组数为4组和5组的轨迹图相近，基于简洁有效呈现方式的考虑，轨迹模型的最优组数选为4组。接着，固定高血压患者收缩压纵向轨迹组的组数为4组，调整阶次，结合图形中轨迹曲线的形态及P值，确定最终轨迹曲线的阶数，分别为1阶(直线)、1阶(直线)、1阶(直线)、2阶(曲线)。拟合的高血压患者收缩压纵向轨迹模型评价如表2所示，各轨迹组的AvePP均大于70%，模型拟合程度较好。最终轨迹图如图1所示，21.8%的高血压患者为1级高血压逐步下降组；55.5%的高血压患者为1级高血压水平稳定组；15.6%的高血压患者为2级高血压水平增长组；7.2%的高血压患者为2级高血压逐步下降组。
2.2 高血压患者收缩压纵向轨迹
本研究满足重复测量方差分析的基本条件，因协方差矩阵的球形型检验显示P值小于0.05，不满足协方差矩阵球形性检验，故采用Greenhouse-Geisser(G-G)法的校正结果。如表3重复测量方差分析结果显示，不同时点的收缩压值差别有统计学意义；不同轨迹组间收缩压值差别有统计学意义；轨迹分组与时间的交互效应有统计学意义。
2.3 各轨迹组研究对象的基线特征
结果如表4所示，相较于1级高血压逐步下降组和2级高血压逐步下降组，1级高血压水平稳定组和2级高血压稳定增长组的研究对象AB型血型、从不饮酒、服药规律的比例更低；小学及以下的教育程度、未婚的婚姻状态、体重过轻、不锻炼、吸烟、摄盐重、心理调整差、遵医行为差、服药间断的比例更高。
2.4 高血压患者收缩压纵向轨迹的影响因素
结果如表5所示，以1级高血压逐步下降组作为参照组，小学以下的文化程度(OR=82.68，95% CI：75.60~90.42)、偶尔锻炼(OR=2.77，95% CI：2.19~3.50)、经常饮酒(OR=1.39，95% CI：1.17~1.64)、遵医行为一般(OR=1.44，95% CI：1.18~1.75)、服药依存间断(OR=2.15，95% CI：1.98~2.34)的人更容易归入2级高血压水平增长组。以1级高血压逐步下降组作为参照组，年龄每增长1岁(OR=1.03，95% CI：1.02~1.03)、服药规律(OR=1.94，95% CI：1.79~2.11)更容易归入2级高血压逐步下降组，而小学以下文化程度(OR=0.80，95% CI：0.73~0.87)、体重正常(OR=0.72，95% CI：0.65~0.79)、每天锻炼(OR=0.92，95% CI：0.86~0.99)、从不饮酒(OR=0.51，95% CI：0.45~0.56)的人更不容易归入2级高血压逐步下降组。
3 讨论
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3.1 高血压患者收缩压纵向轨迹分析
基于文献查阅，现有血压纵向轨迹研究多针对于青少年和中老年健康人群，缺少针对高血压人群血压轨迹的研究[8,17]。本研究通过组基-轨迹模型拟合出4条轨迹，其中1级高血压水平稳定组所占比例最高(55.5%)。这说明高血压患者收缩压变化具有群体异质性，其中大部分高血压患者的血压值波动不大，但未达到控制要求。
Yao等人对中国成人的血压轨迹变化进行了研究，构建3个SBP轨迹组：“低初始血压和轻微升高组”、“初始血压低，中度升高组”、“高初始血压和高升高组”[9]。黄金杰等人研究在职及离退休职工的血压轨迹变化，构建 5个SBP轨迹组：低-稳定轨迹组、中-稳定轨迹组、中-高轨迹组、高-中轨迹组及高-稳定轨迹组[18]。然而，这些研究人群都不是高血压人群，且没有依据高血压防治指南血压分级对血压轨迹进行命名与划分。
3.2 高血压患者收缩压纵向轨迹的影响因素
经文献查阅，以往关于高血压患者血压控制影响因素的研究大多将高血压患者分为达标组和未达标组，通过逻辑回归分析影响因素[19]。而基于高血压患者的纵向血压轨迹将高血压患者进行更细致的分类，进而研究血压控制影响因素的研究还处于空白。
本研究发现年龄每增长一岁更容易归入2级高血压逐步下降组。姚溪研究也发现，≥60岁和45~59岁人群高血压控制率高于18~44岁人群。这可能是由于年龄大的高血压患者对血压更加关注，服药更加规律，因此血压控制情况更好[11]。而Jiang等人的研究没有发现年龄与血压控制有关，这可能是由于其研究对象是高血压门诊患者，且样本量小[19]。本研究结果发现，与1级高血压逐步下降组相比，初中及以下的教育程度、不经常锻炼、摄盐重、服药依存性间断的人更容易归入2级高血压水平增长组。这与大部分血压控制效果影响因素的结果一致[20-23]。
本研究在高血压患者中构建收缩压的组基-轨迹模型以及通过不同的收缩压纵向轨迹来研究血压控制效果的影响因素具有创新性和新颖性。其次，本研究高血压患者的血压值是通过健康体检获取，避免了自我报告偏倚。但本研究也存在局限性。首先，研究对象抽自山东省且未纳入全部高血压患者，外推结论时要谨慎。其次，血压轨迹变化的影响因素复杂多样，本研究并未涵盖全部因素，如具体的用药种类等因素。最后，由于血压监测仪不统一而导致测量偏倚的存在和部分暴露变量是通过患者自我报告获取而可能存在自我报告偏倚。
综上，山东省居民高血压患者的血压纵向轨迹可分为1级高血压逐步下降组、1级高血压水平稳定组、2级高血压水平增长组、2级高血压逐步下降组。与1级高血压逐步下降组相比，小学以下的文化程度、偶尔锻炼、经常饮酒、遵医行为一般、服药依存间断的人更容易归入2级高血压水平增长组，年龄每增长一岁，文化水平较高、肥胖、不锻炼、经常饮酒、服药规律更容易归入2级高血压-稳定下降组。未来对高血压患者的干预设计中，可以根据其内部异质性，尤其是在2级高血压水平增长组人群中针对其特有危险因素，实施更有效率的评估与干预。
基金
收起
  • 国家自然科学基金项目(82273702)
  • 山东省优秀青年学者(海外)科学基金项目(2022HWYQ-030)
  • 泰山学者工程专项基金项目(tsqnz20221103)
  • 齐鲁青年学者项目(202099000066)
文献
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202308260
  • 接收时间：2023-08-16
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-08-16
基金
国家自然科学基金项目(82273702)
山东省优秀青年学者(海外)科学基金项目(2022HWYQ-030)
泰山学者工程专项基金项目(tsqnz20221103)
齐鲁青年学者项目(202099000066)
作者信息
    1.山东大学公共卫生学院流行病学系，山东 济南 250012
    2.山东省疾病预防控制中心健康管理所

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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