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一个以社区为基础的综合干预措施,以减少高血压的心血管风险 (HOPE 4):一个集群随机对照试验

Jon-David Schwalm¹, Tara McCready¹, Patricio Lopez-Jaramillo²

¹Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.

Lancet (London, England)

|September 7, 2019

概括

一个由非医疗保健工作者领导的新护理模式显著降低了高血压患者的心血管疾病风险. 这种医生和家人支持的方法比常规护理更有效.

科学领域:

心血管医学
公共卫生
医疗服务研究

背景情况:

高血压是导致心血管疾病 (CVD) 的全球主要原因,控制率低于最佳水平.
有效的高血压管理对于降低心血管疾病风险至关重要.
一个全面的,以当地情况为基础的策略可能会改善与常规护理相比的结果.

研究的目的:

评估高血压管理的综合护理模式.
在社区试验中评估非医生卫生工作者的影响.
确定该模型是否能降低10年内心血管疾病风险.

主要方法:

HOPE 4试验是在哥伦比亚和马来西亚进行的集群随机对照试验.
这项干预涉及使用算法,医生监督的药物和家庭支持的NPHW.
1371名参与者被随机分为干预 (n=644) 或常规护理 (n=727).

主要成果:

干预组的10年心血管疾病风险显著降低 (差异为- 4. 78%,p< 0. 0001).
在干预组中观察到压缩血压 (-11. 45 mm Hg) 和LDL胆固醇 (- 0. 41 mmol/ L) 的较大降低 (p< 0. 0001).
在干预组中,血压控制 (< 140 mm Hg) 的改善显著 (69% vs 30%, p< 0. 0001).

结论:

由医生和家人支持的全方位护理模式有效降低心血管疾病风险.
这种实用,有背景的策略优于通常的高血压管理.
这种模式有可能被广泛实施以减少心血管疾病的负担.

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