Analysis of clinical efficacy of comprehensive nursing intervention on elderly patients with hypertension combined with hyperuricemia

Objective: To evaluate the clinical efficacy of the comprehensive nursing intervention on elderly patients with hypertension combined with hyperuricemia. Methods: This was a retrospective study. One hundred elderly patients with hypertension combined with hyperuricemia admitted to the Baoding No.1 Central Hospital from May 2019 to May 2020 were included and randomly divided into two groups. Patients in the control group were treated with conventional nursing intervention, while those in the experimental group were treated with comprehensive nursing intervention based on the therapy in the control group. The improvement of compliance behavior, clinical efficacy, quality of life and satisfaction with hypertension combined with hyperuricemia before and after treatment were compared and analyzed between the two groups. The proportion of patients in both groups who developed gout or renal insufficiency was recorded, and their long-term treatment outcomes were compared and analyzed. Results: After the comprehensive nursing intervention, the number of cases of compliance behaviors in the experimental group was significantly higher than that in the control group(p<0.05). The systolic and diastolic blood pressure and uric acid levels were significantly lower in the experimental group compared to the control group after the intervention(p=0.00). The scores of physical function, psychological function, social function and material life status improved significantly in the experimental group compared to the control group after the intervention(p=0.00). The satisfaction rate of the experimental group was significantly higher than the control group(p=0.02). The proportion of patients in the experimental group who developed gout was significantly lower than that in the control group(p=0.03). Conclusion: Comprehensive nursing intervention plays a vital role in the treatment and prognosis of hypertension combined with hyperuricemia.


INTRODUCTION
Uric acid, as the end product of purine base metabolism in nucleic acids, is generally produced from hypoxanthine and xanthine, products of the purine synthesis process, catalyzed by xanthine oxidase. 1 Excessive blood uric acid exerts its strong oxidative effect and causes damage to the body.Yip et al. 2,3 Concluded that asymptomatic hyperuricemia has a close bearing on a variety of comorbidities, including hypertension, chronic kidney disease, coronary artery disease and diabetes mellitus.Changes in people's lifestyles have gradually increased the level of blood uric acid.In recent years, hypertension combined with hyperuricemia has become a common condition that makes inroads in the elderly.
Hypertension combined with hyperuricemia is a chronic process that requires increased awareness and compliance in the treatment of elderly patients with this condition. 4Comprehensive nursing intervention is a new type of nursing care that is tailored to a particular disease and patient's condition in a pre-determined way. 5 A growing body of evidence shows 6 that comprehensive nursing has advantages in improving patients' perceptions of care as well as treatment adherence.Clearly, nursing staff plays an important role here.It was found that nursing interventions taken in the treatment of gout and hyperuricemia can play a positive role. 7Scientific and rational nursing interventions are an important part of the treatment of gout and hyperuricemia. 8With the current rapid development of nursing, comprehensive nursing intervention, an intervention method based on continuum thinking, is also widely used in clinical practice.It boasts many advantages, such as personalized, holistic, and effective. 9,10n this study, the comprehensive nursing intervention was used in the clinical diagnosis and treatment of elderly patients with hypertension combined with hyperuricemia, and certain effects were obtained.

METHODS
This was a retrospective study.One hundred elderly patients with hypertension combined with hyperuricemia admitted to the Baoding No.1 Central Hospital from May 2019 to May 2020 was included and randomly divided into two groups: the experimental group and the control group, with 50 cases in each group.No statistically significant difference was observed between the two groups in the comparison of general information ( The experimental group adopted a comprehensive nursing intervention based on the treatment plan of the control group, as follows:

Popularization of knowledge of hypertension and hyperuricemia:
The nurses popularized relevant knowledge of hypertension and hyperuricemia to patients to help them actively prevent and treat the disease.Diet care: For patients with hypertension, sodium intake should be controlled below 6g per day.For those with hyperuricemia, the intake of purine-rich foods should be strictly limited.Psychological nursing: The nurses followed up on patients' psychological status in time to help them regulate their mood to avoid patients' bad emotions from affecting the treatment effect.Exercise nursing: The nurses helped the patients to make corresponding exercise plans according to their own conditions.Control patients' weight and improve body function.

Clinical medication nursing:
The nurses should continue to remind patients to take rational medication according to regulations, and urge them to regularly monitor blood uric acid and blood pressure.

Observation indicators:
Treatment compliance: including adherence to standardized medication, regular measurement of blood pressure and uric acid, adherence to diet, adherence to smoking and alcohol cessation, and adherence to aerobic exercise.Clinical efficacy: The differences in systolic blood pressure, diastolic blood pressure and uric acid levels were compared between the two groups.

Quality of life:
The Generic Quality of Life Inventory-74 (GQOLI-74) was used to assess the quality of life.The higher the score, the better the patient's quality of life. 13omparative analysis of patient satisfaction: The Patient Satisfaction Questionnaire Short Form (PSQ-18) 14 was used for patients, relatively satisfied, satisfied, and not satisfied, with total satisfaction = (very satisfied + relatively satisfied + satisfied)/total number of cases x 100%.Follow up: All patients were followed up for two years.The proportion of patients in both groups who developed gout or renal insufficiency was recorded, and their longterm treatment outcomes were compared.

Statistical analysis:
All data in this study were statistically analyzed by SPSS 20.0 software, and measurement data were expressed as ( ).Two independent sample t-test was used for comparison between groups, paired t-test was used to analyze data within groups, and c 2 test was used for the comparison of rates, the power of test / confidence interval is 95%.P<0.05 indicates a statistically significant difference.

RESULTS
After the comprehensive nursing intervention, the number of cases of compliance behaviors in the experimental group was significantly higher than that in the control group (p<0.05)(Table-II).The systolic and diastolic blood pressure and uric acid levels were significantly lower in the experimental group compared to the control group after the intervention (p=0.00)(Table-III).The scores of physical function, psychological function, social function and material life status improved significantly in the experimental group compared to the control group after the intervention (p=0.00)(Table -

IV).
The satisfaction rate of the experimental group was 94%, which was significantly higher than 78% in the control group (p=0.02)(Table-V).The proportion of patients in the experimental group who developed gout was significantly lower than that in the control group (p=0.03)(Table-VI).

DISCUSSION
It was confirmed in our study that after the comprehensive nursing intervention, the number of cases of compliance behaviors in the experimental group was significantly higher than that in the control group.The systolic and diastolic blood pressure and uric acid levels were significantly lower in the experimental group compared to the control group after the intervention.The scores of physical function, psychological function, social function and material life status improved significantly in the experimental group compared to the control group after the intervention.The satisfaction rate of the experimental group was significantly higher than the control group.
Hyperuricemia (HU), a common disease in middleaged and elderly patients, occurs as a result of a series of metabolic diseases which caused by high blood uric  Patients with Hypertension Combined with Hyperuricemia acid levels in the organism mainly due to disorders of purine metabolism. 15Hyperuricemia is the biochemical basis of gout.Some studies have pointed out that 5% to 19% of patients with hyperuricemia develop gout later. 16It has been shown in related studies that elevated levels of uric acid in the body have a strong correlation with hypertension, and HU has become a risk factor for causing cardiovascular disease. 17Data showed 18 that HU often coexists with cardiovascular disease, hypertension, obesity, dyslipidemia, and diabetes.HU has become an independent risk factor for cardiovascular disease.Despite the treatment methods for patients with hypertension and hyperuricemia are now relatively mature, their prognostic links are still weak.To explain the reasons, patients and their families are not sufficiently aware of the etiology of the disease, precautions, and reasonable lifestyle habits, which bring some interference in the prognosis of the disease. 19Therefore, health education is provided to patients during hospitalization to popularize the basic knowledge of the disease, establish reasonable dietary standards, perform an appropriate exercise, and adhere to medication as prescribed, etc., to help patients improve their knowledge of disease prevention and treatment.Comprehensive nursing interventions can be combined with the prognostic regression of the disease and the psychological characteristics of patients to take targeted nursing guidance, while continuous care after discharge can reduce adverse emotions, which is a scientific extension of in-hospital care. 20he proportion of patients in the experimental group who developed gout was significantly lower than that in the control group.It can be seen that comprehensive nursing intervention is of great clinical significance and can significantly improve clinical efficacy.Specifically, going through a comprehensive nursing intervention means that patients are able to receive targeted interventions at each stage, which is of great significance for improving treatment outcomes.The conclusion of this study provides additional clinical reference for the clinical application of comprehensive nursing intervention in hypertensive patients with HU.
Limitations: It includes small sample size and the followup period was short.In future, more patients will be included and follow-up time will be extended to more objectively evaluate the pros and cons of this intervention, so as to benefit more patients.

CONCLUSION
To put it in a nutshell, after comprehensive nursing intervention, the clinical efficacy and long-term therapeutic effect of HU patients with hypertension were significantly improved.Therefore, comprehensive nursing intervention plays a vital role in the treatment and prognosis of hypertension combined with HU.

Source of funding:
This study was sponsored by Science and Technology Projects in Baoding (No. 2141ZF065).

Declaration of conflicting interest:
The authors declare that there is no conflict of interest. Table-I).

Table - I
: Comparative analysis of general information between the experimental group and the control group ( ) n=50.

Table -
II: Comparative analysis of the improvement of compliance behavior between the two groups before and after treatment ( ) n=50.

Table - V
: Comparative analysis of satisfaction between the two groups ( ) n=50.
Na Lu et al.

Table -
IV: Comparative analysis of quality of life scores between the two groups before and after the intervention ( ) n=50.