背景: 高血压是我国重要的公共卫生问题，患病率高但控制率低。家庭血压监测有利于提高诊断准确性、改善血压控制情况、预测心血管风险及预后等，我国和国际诊疗指南均推荐高血压患者规律进行家庭血压监测。因此有必要了解我国目前高血压患者家庭血压监测应用情况，以及家庭血压监测与依从降压治疗的关联关系。

目的：本研究旨在描述我国高危高血压患者的家庭血压监测应用情况，及其在接受血压达标干预时的服药依从性；分析规律进行家庭血压监测的影响因素；探究家庭血压监测与依从降压治疗的关联关系，为改善血压控制情况提供依据。

方法：利用一项多中心随机对照临床试验“强化降低收缩压治疗对预防心血管事件作用的研究（ESPRIT 研究）”的基线和随访 1 年的数据进行分析。ESPRIT 研究于2019 年 9 月～2020 年 7 月从全国 23 个省/直辖市的 116 家医院及卫生服务中心入选具有心血管疾病高危风险的受试者，询问患者特征、高血压知识知晓情况、平时使用血压计的类型及测量血压的频率，记录诊室血压测量结果。1 年随访期间至少进行 6 次面访，询问患者当前用药情况，包括服用降压药物的种类和依从性，通过药片计数结合自我报告的方式评估服药依从性。采用多水平 Logistic 回归模型分析规律进行家庭血压监测的影响因素，采用 Log-binomial 回归模型探究不同监测频率与服药依从性的关联关系，以 P＜0.05 为差异具有统计学意义。

结果：共纳入 11212 例高血压患者，平均年龄 64.6±7.1 岁，女性占 41.3%。所有患者中 82.1%拥有血压计，其中上臂式电子血压计占 79.5%；每日、每周、每月监测血压的占比分别为 23.6%、40.2%、24.8%；所有患者中 59.4%规律进行家庭血压监测，即家中有血压计且每周至少测量一次血压。高龄（OR=1.24，95%CI：1.06-1.44）、服用多种降压药物、知晓高血压诊断标准（OR=1.27，95%CI：1.15-1.40）、知晓高血压治疗目标值（OR=1.12，95%CI：1.01-1.24）、知晓多个高血压并发症（OR=1.38,95%CI：1.15-1.65）的患者规律进行家庭血压监测的可能性更大。在 12 个月的随访中，有 30.8%的患者至少发生过一次因主观原因未规律服药，其中 79.7%认为病情好转自行减量或停药。降压治疗观念正确的患者中，家庭血压监测频率与服药依从性无明显关联。降压治疗观念不正确的患者中，与监测频率低于每月一次的患者相比，每月或每周监测的患者服药依从性的差异无统计学意义，每日监测的患者依从降压治疗的概率减少 12%（RR=0.88，95%CI：0.81-0.96）。

结论：我国高危高血压患者中近半数未规律进行家庭血压监测，在严格的血压管理下仍有近三成发生过因主观原因服药不依从。在降压治疗不正确的患者中，每日监测血压的患者更容易出现因主观原因服药不依从。加强高血压知识的健康宣教，推荐患者规律进行家庭血压监测的同时，告知正确的家庭血压目标值，督促其不因血压达标而自行停药或减药对于改善血压控制情况更为重要。

Background: Hypertension is a major public health issues, with high prevalence and poor control. Home blood pressure monitoring (HBPM), an important way to improve diagnosis accuracy and blood pressure (BP) control or predict cardiovascular outcomes, is recommended by international guidelines. There is necessity to describe prevalence of
HBPM in patients with hypertension in China, and the association between HBPM and medication adherence.

Objective: Aim to describe the HBPM status and medication adherence under optimal BP management in hypertensive patients at high risk of cardiovascular disease (CVD), analyze the factors influencing regular monitoring, and explore the association between HBPM and medication adherence. To provide evidence for improving BP control .

Methods: Used baseline and 1-year follow-up data from a multi-center, randomized, controlled clinical trial, the Effect of Intensive Systolic Blood Pressure Lowering Therapy on the Prevention of Cardiovascular Events (ESPRIT) Study. Hypertensive patients at high CVD risk were enrolled from 116 hospitals and health care centers in 23 provinces in China from September 2019 to July 2020. Patients characteristics, knowledge of hypertension, frequency of monitoring and type of BP monitors were obtained through electronic questionnaires. Information about medication use were
collected in six or more interviews during 1-year follow-up, medication adherence was measured by combination of counting pills and self-report. A multi-level Logistic
Regression Model was used to evaluate the factors influencing regular HBPM use, and a Log-binomial Regression Model was used to explore the association between different monitoring frequencies and medication adherence. P<0.05 was considered statistically significant.

Results: A total of 11212 hypertensive patients were included, with an average age of 64.6±7.1 years, females accounted for 41.3%. Overall, 82.1% had a BP monitor, of which 79.5% had an upper-arm electronic device. The proportion of patients who monitored BP daily, weekly and monthly was 23.6%, 40.2% and 24.8%, separately. Among all patients, 59.4% underwent regular HBPM (had a device and measured BP at least weekly).
Patients who had older age (OR=1.24, 95%CI:1.06-1.44), more antihypertensive drugs, better awareness of hypertension knowledge about diagnostic criteria (OR=1.27, 95%CI:1.15-1.40), treatment target (OR=1.12, 95%CI:1.01-1.24), hypertension complications (OR=1.38, 95%CI:1.15-1.65) were more likely to monitor home BP regularly. Overall, 30.8% of patients had medication non-adherence record for subjective
reasons, among whom 79.7% discontinued on their own because of symptom improved. For patients who had correct perception of antihypertensive treatment, there was no
correlation between monitoring frequency and medication medication. For patients who had incorrect perception, compared with patients who monitored BP less than monthly,
there was no statistically significant difference in medication adherence among patients who monitored BP monthly or weekly, patients who monitored BP daily had a 12% lower
probability of adhering to antihypertensive treatment (RR=0.88, 95%CI:0.81-0.96).

Conclusions:Nearly half of the high CVD risk hypertensive patients conducted HBPM irregularly, and nearly thirty percent patients had non-adherence with medication for subjective reasons under optimal management. Among patients with incorrect perception of antihypertensive treatment, patients who monitored BP daily were more likely to have non-adherence with medication for subjective reasons. Strengthening the health education of hypertension knowledge, recommending patients to conduct regular HBPM, informing home BP target, and urging them not to withdraw on their own is important to improve BP control.