界首市农村地区高血压患者服药情况及影响因素研究：基于家庭医生签约服务

Background??Hypertension is a major risk factor for cardiovascular disease. Antihypertensive drug therapy should not only consider the characteristics of the patient's blood pressure but also the patient's comorbid conditions. Currentlythere is a lack of research on the medication status and influencing factors of hypertensive patients based on family doctor services. Objective??To investigate the current medication status of hypertensive patients who purchased family doctor contract services in Jieshou CityAnhui Provinceto describe the association between patient medication behavior and patient characteristicsto explore the influencing factors of medication adjustmentand to analyze the rationality of medication use in primary hypertensive patients. Methods ?Using cluster samplingfrom July to August 202148 administrative villages were randomly selected from Jieshou CityAnhui. Data on patient characteristics and medication were collected through face-to-face interviews using a self-made questionnaire. According to the "National Guidelines for the Prevention and Management of Hypertension at the Primary Level2020 Edition"the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categoriescategory A includes angiotensin-converting enzyme inhibitorsACEIsand angiotensin receptor blockersARBscategory B includes beta-blockerscategory C includes calcium channel blockersCCBscategory D includes diureticsand category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of iFLYTEK's intelligent voice blood pressure monitor to analyze the medication behavior of patients with different characteristics. Multivariate Logistic regression analysis was used to explore the influencing factors of medication adjustment in hypertensive patients. In this study"combination medication" refers to taking a combination drug or two or more antihypertensive drugsand "medication adjustment" refers to patients previously taking other antihypertensive drugs. Results??A total of 3005 hypertensive patients were included in this studyincluding 1 291 males43.0%and 1 714 females57.0%with an average age of65.59.8years. The medication rate of hypertension was 79.1%and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugsthe rates of different types of antihypertensive drugs from high to low weresome patients had combination medicationcategory E39.6%category C35.1%category D20.3%category A20.1%and category B3.7%the most frequently taken antihypertensive drug was compound lisinopril33.7%. For patients with an average annual blood pressure 160/100 mmHg12.2% and 4.9% still did not take antihypertensive drugs. Patients'?combination medication mainly involved category E antihypertensive drugs. For patients with an average annual "diastolic pressure 100 mmHg" and "with complications"the rates of adjusted category A and C antihypertensive drugs increased relatively morefor patients with an average annual "systolic pressure 160 mmHg" and "without complications"the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medicationOR=1.04295%CI=1.031-1.053P<0.001education level above junior high schoolOR=1.48895%CI=1.195-1.853P<0.001combined hyperlipidemiaOR=1.26795%CI=1.052-1.525P=0.013combined cardiovascular complicationsOR=1.39495%CI=1.166-1.667P<0.001and combined cerebrovascular complicationsOR=1.25895%CI=1.040-1.522P=0.018were promoting factors for medication adjustment in patientswhile advanced ageOR=0.98095%CI=0.971-0.990P<0.001was an inhibiting factor for medication adjustment. Conclusion??The medication rate among rural hypertensive patients in Jieshou City is highmainly involving category E and C antihypertensive drugs. The use of various antihypertensive drugs by primary care physicians is generally reasonablebut the management of medicationespecially the application of combination medication strategies for patients with secondary hypertension and those with complicationsneeds to be improved.