原发性高血压患者头痛与肾素活性水平和颈动脉粥样硬化的关系

Association of headaches with plasma renin activity and carotid atherosclerosis in patients with primary hypertension

目的探讨原发性高血压患者头痛与血浆肾素活性水平和颈动脉粥样硬化的关系。方法选取2018年1月至2021年11月贵州医科大学附属医院高血压科收治的291例原发性高血压患者作为研究对象,根据患者就诊主诉症状有无头痛分为头痛组(122例)与无症状组(169例)。检测两组患者立位肾素活性和醛固酮水平,并计算醛固酮与肾素活性比值(aldosterone to renin ratio,ARR),采用彩色多普勒超声诊断仪进行颈动脉超声检查。分析两组间肾素活性水平、ARR和颈动脉粥样硬化的差异。结果头痛组患者年龄、空腹血糖水平显著低于无症状组,差异有统计学意义(P<0.01)。与无症状组比较,头痛组血浆肾素活性显著升高,ARR值显著降低,差异有统计学意义(P<0.01),两组颈动脉粥样硬化发生比例比较,差异无统计学意义(P>0.05)。进一步将头痛作为因变量,采用logistic二元回归分析头痛的影响因素,结果显示,颈动脉粥样硬化、年龄、空腹血糖、血浆肾素活性是头痛发生的影响因素(P<0.05)。结论颈动脉粥样硬化、高肾素活性水平是高血压患者发生头痛的危险因素,而年龄越大、空腹血糖水平越高,头痛发生可能性越低。

Objective To determine the relationship between headaches and plasma renin activity(PRA)and carotid atherosclerosis in patients with essential hypertension.Methods A total of 291 patients with primary hypertension who were evaluated from January 2018 to November 2021 were retrospectively studied.According to the chief complaint(headaches),the patients were divided into headache(n=122)and asymptomatic groups(n=169).The standing PRA and aldosterone levels of the two groups were determined,and the aldosterone-to-renin ratio(ARR)was calculated.Carotid artery atherosclerosis was evaluated with color Doppler ultrasonography.The differences in PRA and carotid artery injury between the two groups were analyzed.Results Age and the fasting plasma glucose level in the headache group were significantly lower than the asymptomatic group(P<0.01).Compared with the asymptomatic group,the PRA was significantly increased and the ARR was significantly decreased in the headache group(P<0.01),while there was no significant difference in the degree of carotid atherosclerosis between the headache and asymptomatic groups(P>0.05).Designating headache as the dependent variable,and age,fasting plasma glucose level,ARR,PRA,and degree of carotid atherosclerosis as independent variables,logistic regression analysis showed that carotid atherosclerosis,age,fasting plasma glucose level,and PRA were associated with the occurrence of headaches(P<0.05).Conclusions Carotid atherosclerosis and high PRA are risk factors for headaches in hypertensive patients.Older patients with a higher fasting plasma glucose level are less likely to have headaches.