家庭血压监测对伴焦虑或抑郁情绪高血压患者降压治疗的影响

Home blood pressure monitoring in antihypertensive treatment for hypertensive patients with anxiety or depression

  • 摘要: 背景家庭血压监测(HBPM)有助于评估高血压患者的血压水平和指导降压治疗,有助于白大衣高血压的鉴别,但也可能加重伴焦虑或抑郁的高血压患者的情绪障碍。目的探讨伴焦虑或抑郁情绪的高血压患者使用HBPM对降压治疗达标的影响,以评估HBPM是否适用于伴焦虑或抑郁情绪的高血压患者。方法选取789例同一社区确诊的高血压患者,给予焦虑自评量表和抑郁自评量表自评,根据自评得分值分为轻度焦虑、中重度焦虑、轻度抑郁、中重度抑郁、无情绪障碍,并按血压监测方式将每种情绪状态的患者随机分为HBPM组和诊室血压监测(CBPM)组。随访12周。比较应用不同血压监测方式的各组患者自行调整测压次数、自行调整降压药物及血压达标情况。结果伴中重度焦虑情绪的高血压患者,HBPM组自行调整测压次数、自行调整降压药物的人数分别为22(95.7%),16(69.6%),明显多于诊室血压监测组10(45.5%),5(22.7%),P<0.05;研究末诊室血压达标率HBPM组明显低于诊室血压监测组(43.5%比72.7%,P<0.05)。伴中重度抑郁情绪的高血压患者,HBPM组自行调整测压次数、自行调整降压药物的人数分别为14(82.4%),10(58.8%),明显多于诊室血压监测组2(11.8%),3(17.6%),P<0.05;研究末诊室血压达标率HBPM组明显低于诊室血压监测组(23.5%比64.7%,P<0.05)。进行HBPM的患者,中重度焦虑组自行调整测压的频数(0.77±0.37)、自行调整降压药物的频数(0.14±0.04)与轻度焦虑组(0.09±0.04)、(0.08±0.02)和无情绪障碍组(0.06±0.03)、(0.03±0.02)比较,差异有统计学意义(P<0.05);中重度抑郁组自行调整测压的频数(-0.50±0.34)、自行调整降压药物的频数(-0.15±0.02),与轻度抑郁组(-0.80±0.10)、(-0.09±0.02)和无情绪障碍组(0.06±0.03)、(0.03±0.02)比较,差异有统计学意义(P<0.05)。结论伴中重度焦虑或抑郁情绪的高血压患者使用HBPM可因情绪因素干预血压监测和降压治疗方案,影响患者的血压达标,不适宜进行HBPM。

     

    Abstract: Background Home blood pressure monitoring(HBPM) has been recommended to evaluate blood pressure,to guide antihypertensive treatment for hypertensive patients and to diagnose white-coat hypertension.However,abnormal BP reading in HBPM could also result in aggravation of emotional disorder in hypertensive patients complicated with anxiety or depression.Objective To study the blood-pressure-lowering effects of HBPM on hypertensive patients with anxiety or depression,and evaluate whether HBPM is applicable to this community.Methods A total of 789 cases of diagnosed hypertensive patients from the same community medical center were selected and surveyed with self-rating anxiety scale(SAS) and self-rating depression scale(SDS).According to the self-evaluation scores,all subjects were divided into five hypertension groups with slight anxiety,moderate or severe anxiety,slight depression,moderate or severe depression,and no emotional disorder(ED),respectively.Based on the ways of BP monitoring,all patients in each group were randomized into home blood pressure monitoring group(HBPM-group) and clinic blood pressure monitoring group(CBPM-group).After 12 weeks of follow-up,the percentages of those who had self-adjusted BP measurement frequency,of those who had self-regulated antihypertensive drugs and of those who had reached target BP in each group were compared.Results In moderate or severe anxiety ED patients of HBPM group,the percentages of patients self-adjustment BP measurement frequency(22,95.7%) and antihypertensive drugs(16,69.6%) were significantly higher than in CBPM group(10,45.4%),(5,22.7%),all P<0.05.At the end of the experiment,the percentage of patients reaching clinic target BP in HBPM-group was lower than in CBPM group(43.5% vs 72.7%,P<0.05).In moderate or severe depression ED patients of HBPM group,the percentages of patients self-adjustment BP measurement frequency(14,82.4%) and antihypertensive drugs frequency(10,58.8%) were significantly higher than in CBPM group(2,11.8%),(3,17.6%),all P<0.05.At the end of experimet,the percentages of patients reaching clinic target BP in HBPM-group was lower than in HBPM group(23.5% vs 64.7%,P<0.05).In moderate or severe anxiety ED patients of HBPM group,the frequency of self-adjusted of BP measurement(0.77±0.37) and frequency of self-adjusted of antihypertensive drugs(0.14±0.04) were significantly higher than in slight anxiety ED patients of HBPM group(0.09±0.04)(0.08±0.02) and in the patients without ED(0.06±0.03)(0.03±0.02) P<0.05.In moderate or severe depression ED patients of HBPM group,the frequency of self-adjusted of BP measurement(-0.05±0.34) and frequency of self-adjusted of antihypertensive drugs(-0.15±0.02) were significantly higher than in slight depression ED patients(-0.08±0.10)(-0.09±0.02) and in the patients without ED(0.06±0.03)(0.03±0.02) P<0.05.Conclusion HBPM is not applicable to hypertension patients with moderate or severe anxiety or depression,because it could make interference in BP monitoring and antihypertensive treatment,and hinder the patients in reaching target BP by their emotional disorders.

     

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