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摘要: 目的 探讨智慧化高血压远程管理模式在高血压患者管理中的实用效果。 方法 研究对象为2022年2月—2023年11月在安徽医科大学附属第一医院就诊的高血压患者，分为对照组和实验组，对照组采用普通血压管理模式，实验组采用智慧化高血压远程管理模式，各管理3个月。评价项目包括血压、血糖、血脂、尿酸、肌酐、体重指数(body mass index，BMI)、药物依从性、肱踝脉搏波传导速度(brachial-ankle pulse wave velocity，baPWV)及血流介导的血管扩张功能(flow mediated dilation，FMD)的变化。 结果 与管理前比较，管理后两组收缩压下降、舒张压下降、FMD升高、baPWV下降(P＜0.05)。与对照组管理后比较，实验组管理后收缩压下降、舒张压下降、总胆固醇下降、尿酸下降、LDL-C下降、血糖下降、baPWV下降、FMD升高、药物依从性升高(P＜0.05)。 结论 智慧化高血压远程管理模式可有效提高血压控制效果，提高患者服药依从性，改善高血压患者baPWV及FMD指标。Abstract: Objective To explore the practical effect of intelligent remote hypertension management mode in the management of hypertension patients. Methods The subjects were hypertension patients who were treated in the First Affiliated Hospital of Anhui Medical University from February 2022 to November 2023. They were divided into control group and experimental group. The control group adopted the general blood pressure management mode, and the experimental group adopted the intelligent remote hypertension management mode, and each was managed for 3 months. Evaluation items included blood pressure, blood glucose, lipids, uric acid, creatinine, body mass index(BMI), medication adherence, brachial-ankle pulse wave velocity(baPWV) and flow mediated dilation(FMD). Results Compared with before management, systolic blood pressure decreased, diastolic blood pressure decreased, FMD increased and baPWV decreased in both groups after management(P < 0.05). Compared with the control group, systolic blood pressure, diastolic blood pressure, total cholesterol, uric acid, LDL-C, blood glucose, baPWV were decreased, FMD and medication adherence were increased in the experimental group after management(P < 0.05). Conclusion Intelligent remote hypertension management model can effectively improve the effect of blood pressure control, improve patients' medication compliance, and improve the indexes of baPWV and FMD in hypertensive patients.
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Key words:
- hypertension /
- remote management /
- pulse wave velocity /
- vascular endothelial function
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图 1 智慧化高血压远程管理平台介绍
Figure 1. Introduction to the intelligent remote hypertension management platform
表 1 两组基线数据比较
Table 1. General data
例(%), X±S 项目 对照组(86例) 实验组(86例) t/χ2 P 年龄/岁 45.76±10.84 42.94±10.87 1.700 0.091 BMI/(kg/m2) 25.78±3.19 25.99±3.29 -0.438 0.662 收缩压/mmHg 139.85±10.81 141.73±13.23 -1.023 0.308 舒张压/mmHg 88.59±9.11 90.08±11.66 -0.933 0.352 药物 ACEI/ARB 44(51.2) 50(58.1) 0.845 0.358 β受体阻滞剂 23(26.7) 21(24.4) 0.122 0.727 钙离子拮抗剂 49(57.0) 46(53.5) 0.212 0.646 利尿剂 10(11.6) 13(15.1) 0.452 0.502 吸烟 16(18.6) 17(19.8) 0.037 0.846 饮酒 25(29.1) 28(32.6) 0.245 0.620 饮食 0.459 0.795 高盐 37(43.0) 41(47.7) 适中 38(44.2) 36(41.9) 低盐 11(12.8) 9(10.4) 运动 0.489 0.783 不运动 42(48.8) 44(51.2) 有时运动 35(40.7) 31(36.0) 达标 9(10.5) 11(12.8) 注：BMI：体重指数，ACEI：血管紧张素转换酶抑制剂；ARB：血管紧张素受体拮抗剂。 
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表 2 两组管理前后血压、代谢、血管功能和药物依从性比较
Table 2. Blood pressure, metabolism, vascular function and medication compliance before and after management
X±S, M(IQR) 项目 管理前 管理后 对照组(86例) 实验组(86例) t/Z P 对照组(86例) 实验组(86例) t/Z P 收缩压/mmHg 139.85±10.81 141.73±13.23 -1.023 0.308 134.87±11.531) 127.92±11.172) 4.016 ＜0.01 舒张压/mmHg 88.59±9.11 90.08±11.66 -0.933 0.352 84.98±8.861) 79.73±8.422) 3.979 ＜0.01 TC/(mmol/L) 4.78±0.78 4.80±0.67 -0.158 0.875 4.75±0.72 4.22±0.70 4.858 ＜0.01 尿酸/(μmol/L) 370.21±90.02 369.31±71.31 0.072 0.942 362.94±91.56 323.71±63.12 3.272 0.001 LDL-C/(mmol/L) 2.90±0.69 2.96±0.64 -0.568 0.571 2.86±0.72 2.47±0.60 3.803 ＜0.01 HDL-C/(mmol/L) 1.17±0.19 1.14±0.25 0.716 0.475 1.26±0.24 1.33±0.25 -1.891 0.060 血糖/(mmol/L) 5.40±0.62 5.55±0.61 -1.597 0.112 5.46±0.57 5.17±0.61 3.243 0.001 肌酐/(μmol/L) 69.52±12.86 73.12±12.94 -1.833 0.068 67.83±13.97 66.83±11.51 0.512 0.609 BMI/(kg/m2) 25.78±3.19 25.99±3.29 -0.438 0.662 25.67±3.19 25.79±3.20 -0.243 0.808 FMD/% 4.38(2.12) 4.50(2.23) -0.159 0.873 4.82(1.75)1) 5.68(2.30)2) -2.940 0.003 baPWV/(cm/s) 1 565.51(249.50) 1 561.86(207.63) -0.292 0.770 1 502.66(250.13)1) 1 401.80(234.13)2) -3.300 0.001 药物依从性/分 5.48(2.06) 5.39(2.25) -0.333 0.739 5.90(1.81) 7.16(1.25) -6.244 ＜0.01 与对照组管理前比较，1)P＜0.05；与实验组管理前比较，2)P＜0.05。LDL-C：低密度脂蛋白胆固醇，HDL-C：高密度脂蛋白胆固醇。
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