[目的]探索疾病细节管理在社区高血压管理中的作用。[方法]以健康筛查方法选取浦东新区上钢社区300例高血压患者,对其在基本情况及危险因素综合评估的基础上,通过调整和完善高血压管理的各个细节,规范高血压管理行为。[结果]实施细节管理1年后目标人群其知晓率、服药率、控制率分别由75.3%、63.3%、43.6%提高到89.2%、87.7%、58.9%;降压达标作用明显,高危转中危的占27.8%,中危转低危的占68.5%;危险因素影响有所下降,饮食习惯改善,体力活动更趋合理,依从性提高;患者满意率从65.7%提高到96.3%。[结论]疾病细节管理在社区高血压管理中的正向作用明显,不仅提高了高血压知晓率、治疗率和控制率,减少了危险因素,也提高了社区居民对高血压防治的正确认识,强化了社区高血压的规范化管理。 [Objective] To explore the role of disease detail management in community hypertension management. [Methods] A total of 300 hypertensive patients in Shanggang community of Pudong New Area were selected by health screening method. On the basis of comprehensive assessment of basic conditions and risk factors, all the details of hypertension management were adjusted and perfected to regulate the management of hypertension . [Results] The awareness rate, medication rate and control rate of target population increased from 75.3%, 63.3% and 43.6% to 89.2%, 87.7% and 58.9% respectively after 1 year of implementation of detail management. 27.8% of them were critically ill and 68.5% of them were critically ill. The risk factors were reduced, their eating habits improved, their physical activities were more reasonable and their compliance improved. The satisfaction rate of patients increased from 65.7% to 96.3%. [Conclusion] The positive effect of disease detail management in community hypertension management is obvious, which not only improves the awareness rate, treatment rate and control rate of hypertension, reduces the risk factors, but also improves the community residents’ correct understanding of prevention and treatment of hypertension. Strengthened the standardized management of community hypertension.