【摘要】 背景 高血压是心血管疾病主要的危险因素，降压用药不仅要考虑患者血压特征，也要考虑患者合并症情况。现阶段，基于家庭医生签约服务对高血压患者的服药状况及影响因素研究比较缺乏。目的 调查安徽省界首市家庭医生签约服务的高血压患者服药现状，描述患者服药行为与患者特征之间的关联，探索患者用药调整的影响因素，并分析基层高血压患者用药的合理性。方法 采用整群抽样的方法，于2021年7—8月从安徽省界首市随机抽取48个行政村，通过面对面调查法采用自制问卷收集患者特征和服药数据，参照《国家基层高血压防治管理指南2020版》将问卷中患者提到的降压药分为如下5类：A类为血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）,B类为β受体阻滞剂，C类为钙通道阻滞剂（CCB）,D类为利尿剂，E类为单片复方制剂。通过科大讯飞智能语音血压计的后台获取患者上传的近1年血压数据，分析不同特征患者的服药行为。采用多因素Logistic回归分析探讨高血压患者用药调整的影响因素。本研究中联合用药是指服用复方制剂或2种以上降压药，用药调整是指患者过去服用其他降压药。结果 本研究共纳入高血压患者3 005例，其中男1 291例（43.0%）、女1 714例（57.0%），平均年龄为（65.5±9.8）岁，高血压服药率为79.1%，联合用药率为40.2%。2 376例服用降压药的患者中，不同类型降压药服用率从高到低依次为（部分患者存在联合用药）：E类（39.6%）、C类（35.1%）、D类（20.3%）、A类（20.1%）、B类（3.7%）；服用最多的降压药为复方利血平（33.7%）。对于年均血压≥160/100mm Hg的患者，仍有12.2%和4.9%未服用降压药。患者联合用药以E类降压药为主。年均“舒张压≥100 mm Hg”且“患合并症”的患者，调整后A类和C类降压药的服用率增加相对较多，年均“收缩压≥160 mm Hg”且“未患合并症”的患者，调整后E类降压药的服用率增加相对较多。多因素Logistic回归结果显示，服药年数长（OR=1.042,95%CI=1.031～1.053,P<0.001）、初中以上文化程度（OR=1.488,95%CI=1.195～1.853,P<0.001）、合并高脂血症（OR=1.267,95%CI=1.052～1.525,P=0.013）、合并心血管疾病（OR=1.394,95%CI=1.166～1.667,P<0.001）、合并脑血管疾病（OR=1.258,95%CI=1.040～1.522,P=0.018）是患者用药调整的促进因素，高龄（OR=0.980,95%CI=0.971～0.990,P<0.001）是用药调整的抑制因素。结论 界首市农村地区高血压患者的服药率较高，主要服用E类和C类降压药。服药年数长、初中以上文化程度、合并高脂血症、合并心脑血管疾病是患者用药调整的促进因素，高龄是用药调整的抑制因素。更多还原

【Abstract】 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. Currently,there 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 City,Anhui Province,to describe the association between patient medication behavior and patient characteristics,to explore the influencing factors of medication adjustment,and to analyze the rationality of medication use in primary hypertensive patients. Methods Using cluster sampling,from July to August 2021,48 administrative villages were randomly selected from Jieshou City,Anhui. 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 Level(2020 Edition)",the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categories:category A includes angiotensin-converting enzyme inhibitors(ACEIs)and angiotensin receptor blockers(ARBs),category B includes beta-blockers,category C includes calcium channel blockers(CCBs),category D includes diuretics,and category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of i FLYTEK’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 drugs,and "medication adjustment" refers to patients previously taking other antihypertensive drugs. Results A total of 3,005 hypertensive patients were included in this study,including 1 291 males(43.0%)and 1 714 females(57.0%),with an average age of(65.5±9.8)years. The medication rate of hypertension was 79.1%,and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugs,the rates of different types of antihypertensive drugs from high to low were(some patients had combination medication):category E(39.6%),category C(35.1%),category D(20.3%),category A(20.1%),and category B(3.7%);the most frequently taken antihypertensive drug was compound lisinopril(33.7%). For patients with an average annual blood pressure ≥ 160/100 mm Hg,12.2% 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 mm Hg" and "with complications",the rates of adjusted category A and C antihypertensive drugs increased relatively more;for patients with an average annual "systolic pressure ≥ 160 mm Hg" and "without complications",the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medication(OR=1.042,95%CI=1.031-1.053,P<0.001),education level above junior high school(OR=1.488,95%CI=1.195-1.853,P<0.001),combined hyperlipidemia(OR=1.267,95%CI=1.052-1.525,P=0.013),combined cardiovascular diseases(OR=1.394,95%CI=1.166-1.667,P<0.001),and combined cerebrovascular diseases(OR=1.258,95%CI=1.040-1.522,P=0.018)were promoting factors for medication adjustment in patients,while advanced age(OR=0.980,95%CI=0.971-0.990,P<0.001)was an inhibiting factor for medication adjustment. Conclusion The medication rate among rural hypertensive patients in Jieshou City is high,mainly involving category E and C antihypertensive drugs. Longer duration of medication,education level above junior high school,combined hyperlipidemia,combined cardiovascular and cerebrovascular diseases are promoting factors for medication adjustment in patients,while advanced age is an inhibiting factor for medication adjustment.更多还原