Comparison of 24 h Ambulatory Blood Pressure Control Among Hypertensive Patients in Communities in Different Time Periods and Analysis of Its Influencing Factors.

Abstract

Objective To assess the blood pressure control and its influencing factors among hypertensive patients in communities in different time periods by 24 h ambulatory blood pressure monitoring(24 h ABPM)and provide reference for optimizing the health management services for hypertension in communities. Methods A total of 765 hypertensive patients registered in the hypertension management project of national essential public health services in Sanxiang Town,Zhongshan City from October 2022 to September 2023 were identified as target subjects.The 24 h ABPM devices were distributed for blood pressure monitoring and a questionnaire survey was conducted to analyze the influencing factors of blood pressure control. Results Of all the participants,16.5% did not monitor blood pressure regularly,and 59.2% monitored blood pressure 1-2 times per week.The patients who were not on night shifts/staying up late had higher mean rates of achieving the target blood pressure and the circadian rhythm of blood pressure during 24 h,nighttime,and early morning than those who were on night shifts/staying up late(P<0.05 for all).The patients who never drank alcohol had higher rate of achieving the target blood pressure in early morning than those who drank alcohol(P<0.05).The average blood pressure during daytime,nighttime,and 24 h were different by sex(P<0.05 for all).The average blood pressure during nighttime was different by age and job types(P<0.05 for all).The average blood pressure during daytime,nighttime,and 24 h were different in patients with different body weight types(P<0.05 for all).The results of the multivariate logistic regression analysis showed that uncontrolled blood pressure during daytime was more likely to occur in male patients(OR=1.394,95%CI:1.045-1.858,P=0.024),and that during nighttime was more likely to be associated with male patients(OR=1.573,95%CI:1.088-2.275,P=0.016)and night shifts(OR=2.467,95%CI:1.198-5.077,P=0.014).It was difficult to achieve blood pressure control in early morning for the patients who drank alcohol for more than three times per week(OR=4.567,95%CI:1.629-12.807,P=0.004),woke up at night(OR=1.800,95%CI:1.125-2.878,P=0.014),and had night shifts(OR=1.579,95%CI:1.102-2.465,P=0.044).The patients on night shifts were more likely to have abnormal circadian rhythm of blood pressure(OR=1.753,95%CI:1.018-3.018,P=0.043). Conclusion The personal characteristics and lifestyle of hypertensive patients significantly affect the blood pressure control in different time periods(daytime,nighttime,and early morning)and the circadian rhythm of blood pressure.The family doctor team of community healthcare institutions can implement targeted and precise intervention measures for hypertensive patients according to the influencing factors of blood pressure control in different time periods,so as to achieve better management effects.