Lifestyle Modification Counseling for Hypertensive Patients: Results From the National Health and Nutrition Examination Survey 1999-2004
Lifestyle Modification Counseling for Hypertensive Patients: Results From the National Health and Nutrition Examination Survey 1999-2004
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DOI：
10.1038/ajh.2008.348
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发表时间：
2009-03-01
影响因子：
3.2
通讯作者：
Hicks, LeRoi S.
中科院分区：
文献类型：
--
作者：
Lopez, Lenny;Cook, E. Francis;Hicks, LeRoi S.
背景
对于所有被诊断为高血压的患者，都建议改变生活方式。
方法
我们对来自1999 - 2004年美国国家健康与营养检查调查（NHANES）的3497名成年高血压参与者（代表4200万美国人）进行了研究。我们分析了报告接受生活方式咨询以及其依从性的参与者的比率、人口统计学和临床因素。
结果
在3497名高血压参与者中，84%报告接受了生活方式改变的咨询。在对人口统计学和临床特征进行调整后，与白人相比，非西班牙裔黑人更有可能报告接受咨询（优势比（OR），2.5；P < 0.001）。男性（OR，1.5；P = 0.02）报告接受咨询的频率高于女性，拥有医疗保险的人（OR，1.5；P = 0.02）相比于有私人保险的人接受咨询的频率也更高。患有高胆固醇血症（OR，1.7；P < 0.001）、糖尿病（OR，3.5；P < 0.001）、超重（OR，1.5；P < 0.001）或肥胖（OR，3.0；P < 0.001）的参与者比没有这些疾病的参与者更频繁地报告接受生活方式咨询。在接受咨询的人中，88%报告遵守了这些建议。在对人口统计学和临床特征进行调整后，只有非西班牙裔黑人（OR，2.8；P < 0.001）和年龄>60岁的人（OR，1.9；P = 0.04）在接受建议时更有可能报告依从。
结论
心血管高风险的高血压患者接受生活方式咨询的比率较高。然而，对于年轻且心血管低风险的高血压患者，生活方式咨询存在差距。此外，依从率存在差异，特别是在那些患有心血管高风险合并症的患者中。未来需要开展工作以提高所有高血压患者对生活方式咨询的依从性。
BACKGROUNDLifestyle modification is recommended for all patients with the diagnosis of hypertension.METHODSWe examined 3,497 adult hypertensive participants (representing 42 million Americans), from the National Health and Nutrition Examination Survey (NHANES) 1999-2004.We analyzed the rate, demographic, and clinical factors of participants who reported receiving lifestyle counseling and their adherence.RESULTSOf the 3,497 participants with hypertension, 84% reported receiving lifestyle modification counseling. After adjustment for demographic and clinical characteristics, non-Hispanic blacks were more likely to report receiving counseling (odds ratio (OR), 2.5; P < 0.001) when compared to whites. Men (OR, 1.5; P=0.02) reported receiving counseling more often than women as well as those with Medicare insurance (OR, 1.5; P= 0.02) compared to the privately insured. Participants who were hypercholesterolemic (OR, 1.7; P < 0.001), diabetic (OR, 3.5; P < 0.001), overweight (OR, 1.5; P < 0.001), or obese (OR 3.0; P < 0.001) reported receiving lifestyle counseling more often than those without these conditions. Of those receiving counseling, 88% reported adhering to those recommendations. After adjustment for demographic and clinical characteristics, only non-Hispanic blacks (OR, 2.8; P < 0.001) and those aged >60 (OR, 1.9; P=0.04) were more likely to report adhering when advised.CONCLUSIONSHigh cardiovascular risk hypertensive patients had high rates of lifestyle counseling. However, gaps exist in lifestyle counseling for young and low cardiovascular risk hypertensive patients. In addition, differences in rates of adherence exist especially in those with high cardiovascular risk comorbid conditions. Future work is needed to increase adherence to lifestyle counseling for all hypertensive patients.