Evaluation of the application effect of “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases on the improvement of blood pressure in target surveillance population in community

doi:10.3969/j.issn.1674-8115.2022.06.015

Abstract

Abstract: Objective

·To evaluate the effect of “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases on the improvement of blood pressure in target surveillance population in community.

Methods

·Target surveillance population in community who participated in the annual physical examination provided by the National Basic Public Health Service project at least twice in Xintang Town, Zengcheng District, Guangzhou from January 2020 and July 2021 were enrolled, and divided into regular management group (n=2 987) and “co-prevention and co-management” model group (n=2 876) based on whether they had received “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases or not. The regular management group received the regular management mode which included an annual physical examination. In addition to regular treatment, the “co-prevention and co-management” model group received “Internet+ health education”, and their villages were provided with wearable electrocardiogram monitoring equipment. The baseline levels (before the intervention) of the two groups were compared, and the differences of blood pressure changes between the two groups before and after the interventions were observed. Covariance analysis was used to analyze whether the effect of different intervention measures on blood pressure was affected by its baseline blood pressure level. Multi-variable linear regression model was used to explore the association between the “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases and the control of blood pressure and other cardio-cerebrovascular disease risk factors.

Results

·Compared with the regular management group, the baseline levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the “co-prevention and co-management” model group were higher (both P=0.000). After the median intervention time of 227 days, the changes of SBP and DBP in the “co-prevention and co-management” model group before and after the interventions were -0.28 mmHg (95% CI -0.94?0.37, P=0.398) and -0.68 mmHg (95% CI -1.09?-0.27, P=0.001), respectively; the changes in the regular treatment group were 2.92 mmHg (95% CI 2.29?3.54, P=0.000) and -0.12 mmHg (95% CI -0.51?0.28, P=0.554), respectively; the differences of SBP and DBP before and after the intervention between the two groups were 3.20 mmHg (95% CI 2.29?4.11, P=0.000) and 0.56 mmHg (95% CI -0.01?1.13, P=0.055), respectively. Covariance analysis showed that after adjusting for SBP before the intervention, compared with the regular treatment group, the SBP in the “co-prevention and co-management” model group was reduced by 2.06 mmHg (P=0.000). In the multi-variable linear regression model, after adjusting the confounding factors, the “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases was associated with lower SBP (P=0.000).

Conclusion

·The application of “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases among target surveillance population in community can help improving the control of systolic blood pressure.

Key words: cardio-cerebrovascular disease, Internet+, co-prevention and co-management, target surveillance population in community, blood pressure

CLC Number:

R544.1

LI Guodong, YAN Shaohua, ZHANG Qiuxia, LEI Li, ZHANG Xinlu, LIANG Hongbin, LU Junyan, XIAO Min, LUO Wei, PU Jun, XIU Jiancheng. Evaluation of the application effect of “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases on the improvement of blood pressure in target surveillance population in community[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 797-804.

Figures/Tables 4

TrendMD

References 22

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Item	Regular management group （n=2 987）	“Co-prevention and co-management” model group （n=2 876）	P value
Age/year	68.88 ± 7.88	69.53 ± 8.01	0.002
Male/n（%）	1 154 （38.63）	1 086 （37.76）	0.509
BMI/（kg·m^-2）	24.43 ± 3.47	24.28 ± 3.69	0.123
Waist circumstance/cm	86.28 ± 9.18	85.45 ± 9.75	0.001
Smoking/n（%）			0.665
Never	2 483 （83.15）	2 393 （83.23）
Current smoker	317 （10.62）	317 （11.03）
Ever smoker	186 （6.23）	165 （5.74）
Drinking/n（%）			0.014
Never	2 576 （86.24）	2 557 （88.91）
Sometimes	279 （9.34）	212 （7.37）
Often	27 （0.90）	17 （0.59）
Everyday	105 （3.52）	90 （3.13）
Exercise/n（%）			0.000
Never	671 （22.46）	974 （33.87）
Sometimes	280 （9.37）	320 （11.13）
At least once a week	56 （1.87）	47 （1.63）
Everyday	1 980 （66.29）	1 535 （53.37）
History of hypertension/n（%）	2 330 （78.00）	2 276 （79.14）	0.305
History of diabetes/n（%）	747 （25.01）	756 （26.29）	0.275
CKD/n（%）	516 （17.50）	635 （22.63）	0.000
Heart rate/bpm	73.44 ± 11.86	72.64 ± 11.90	0.010
SBP/mmHg	142.75 ± 19.34	145.30 ± 19.16	0.000
DBP/mmHg	82.32 ± 11.42	83.65 ± 11.44	0.000
FBG/（mmol·L^-1）	4.80 （4.20， 5.70）	4.71 （4.16， 5.62）	0.055
Scr/（μmol·L^-1）	77.88 （66.28， 93.06）	80.71 （68.30， 96.19）	0.000
eGFR/［mL·（min·1.73m²）^-1］	76.34 （64.80， 88.63）	72.71 （61.25， 85.98）	0.000
TC/（mmol·L^-1）	5.22 （4.50， 5.95）	5.22 （4.55， 5.95）	0.527
TAG/（mmol·L^-1）	1.47 （1.06， 2.11）	1.48 （1.06， 2.20）	0.354
LDL-C/（mmol·L^-1）	3.33 （2.73， 3.95）	3.36 （2.79， 3.96）	0.337
HDL-C/（mmol·L^-1）	1.32 （1.10， 1.58）	1.31 （1.09， 1.58）	0.261
Hypertensive treatment/n（%）	1 582 （53.05）	1 515 （52.79）	0.860
Diabetes treatment/n（%）	611 （20.49）	518 （18.05）	0.020
Statin treatment/n（%）	9 （0.30）	5 （0.17）	0.425

Item	Regular management group （n=2 987）	“Co-prevention and co-management” model group （n=2 876）	P value
Age/year	68.88 ± 7.88	69.53 ± 8.01	0.002
Male/n（%）	1 154 （38.63）	1 086 （37.76）	0.509
BMI/（kg·m^-2）	24.43 ± 3.47	24.28 ± 3.69	0.123
Waist circumstance/cm	86.28 ± 9.18	85.45 ± 9.75	0.001
Smoking/n（%）			0.665
Never	2 483 （83.15）	2 393 （83.23）
Current smoker	317 （10.62）	317 （11.03）
Ever smoker	186 （6.23）	165 （5.74）
Drinking/n（%）			0.014
Never	2 576 （86.24）	2 557 （88.91）
Sometimes	279 （9.34）	212 （7.37）
Often	27 （0.90）	17 （0.59）
Everyday	105 （3.52）	90 （3.13）
Exercise/n（%）			0.000
Never	671 （22.46）	974 （33.87）
Sometimes	280 （9.37）	320 （11.13）
At least once a week	56 （1.87）	47 （1.63）
Everyday	1 980 （66.29）	1 535 （53.37）
History of hypertension/n（%）	2 330 （78.00）	2 276 （79.14）	0.305
History of diabetes/n（%）	747 （25.01）	756 （26.29）	0.275
CKD/n（%）	516 （17.50）	635 （22.63）	0.000
Heart rate/bpm	73.44 ± 11.86	72.64 ± 11.90	0.010
SBP/mmHg	142.75 ± 19.34	145.30 ± 19.16	0.000
DBP/mmHg	82.32 ± 11.42	83.65 ± 11.44	0.000
FBG/（mmol·L^-1）	4.80 （4.20， 5.70）	4.71 （4.16， 5.62）	0.055
Scr/（μmol·L^-1）	77.88 （66.28， 93.06）	80.71 （68.30， 96.19）	0.000
eGFR/［mL·（min·1.73m²）^-1］	76.34 （64.80， 88.63）	72.71 （61.25， 85.98）	0.000
TC/（mmol·L^-1）	5.22 （4.50， 5.95）	5.22 （4.55， 5.95）	0.527
TAG/（mmol·L^-1）	1.47 （1.06， 2.11）	1.48 （1.06， 2.20）	0.354
LDL-C/（mmol·L^-1）	3.33 （2.73， 3.95）	3.36 （2.79， 3.96）	0.337
HDL-C/（mmol·L^-1）	1.32 （1.10， 1.58）	1.31 （1.09， 1.58）	0.261
Hypertensive treatment/n（%）	1 582 （53.05）	1 515 （52.79）	0.860
Diabetes treatment/n（%）	611 （20.49）	518 （18.05）	0.020
Statin treatment/n（%）	9 （0.30）	5 （0.17）	0.425

Variable	Model 1			Model 2			Model 3
Variable	β	95% CI	P value	β	95% CI	P value	β	95% CI	P value
Change in SBP	-3.198	-4.106‒ -2.290	0.000	-2.159	-2.952‒-1.366	0.000	-2.083	-2.893‒-1.273	0.000
Change in DBP	-0.557	-1.127‒0.012	0.055	0.209	-0.273‒0.690	0.396	0.163	-0.329‒0.655	0.517
Change in BMI	0.001	-0.075‒0.078	0.978	0.005	-0.080‒0.070	0.889	-0.008	-0.084‒0.068	0.837
Change in FBG	0.051	-0.052‒0.153	0.332	0.050	-0.043‒0.144	0.291	0.079	-0.014‒0.173	0.095
Change in TC	0.112	0.069‒0.155	0.000	0.116	0.075‒0.157	0.000	0.114	0.073‒0.155	0.000
Change in LDL-C	0.063	0.028‒0.098	0.000	0.069	0.036‒0.102	0.000	0.067	0.034‒0.100	0.000

Variable	Model 1			Model 2			Model 3
Variable	β	95% CI	P value	β	95% CI	P value	β	95% CI	P value
Change in SBP	-3.198	-4.106‒ -2.290	0.000	-2.159	-2.952‒-1.366	0.000	-2.083	-2.893‒-1.273	0.000
Change in DBP	-0.557	-1.127‒0.012	0.055	0.209	-0.273‒0.690	0.396	0.163	-0.329‒0.655	0.517
Change in BMI	0.001	-0.075‒0.078	0.978	0.005	-0.080‒0.070	0.889	-0.008	-0.084‒0.068	0.837
Change in FBG	0.051	-0.052‒0.153	0.332	0.050	-0.043‒0.144	0.291	0.079	-0.014‒0.173	0.095
Change in TC	0.112	0.069‒0.155	0.000	0.116	0.075‒0.157	0.000	0.114	0.073‒0.155	0.000
Change in LDL-C	0.063	0.028‒0.098	0.000	0.069	0.036‒0.102	0.000	0.067	0.034‒0.100	0.000

Variable	Regular management group （n=2 987）	“Co-prevention and co-management” model group （n=2 876）	Changes between the two groups/ ［difference （95% CI）］	P value
Change in BMI/（kg·m^-2）	0.18±1.51	0.18±1.47	0.00 （-0.08‒0.08）	0.978
Change in FBG/（mmol·L^-1）	0.79±1.86	0.84±2.07	-0.05 （-0.15‒0.05）	0.332
Change in TC/（mmol·L^-1）	0.28±0.83	0.39±0.82	-0.11 （-0.15‒ -0.07）	0.000
Change in LDL-C/（mmol·L^-1）	0.03±0.67	0.09±0.66	-0.06 （-0.10‒ -0.03）	0.000