高血压住院患者病因及危险因素分析

Analysis of Etiology and Risk Factors of in-patients with Hypertension

目的分析近年来高血压病因学及危险因素的变化趋势。方法采用回顾性研究方法,分析高血压专科诊断明确的2274例住院患者的病因分类及其危险因素。结果(1)2274例高血压患者中原发性高血压86%,继发性高血压占14%。在继发性高血压中,内分泌性高血压占51·3%,肾血管性高血压占24·8%;肾性高血压占22·3%。(2)原发性醛固酮增多症在继发性高血压中的患病率最高,占40·2%;在肾血管性高血压中,动脉粥样硬化成为肾血管性高血压的主要病因。(3)对原发性高血压的危险因素分析显示超重与肥胖者占总数的76·2%;糖代谢异常者约占总人数的55·3%;脂代谢异常者比例高达69·5%以上;尿酸代谢障碍者约占31·7%。(4)颈动脉增厚、左室肥厚、慢性肾功能不全和脑卒中的发病率分别为38·1%,26·2%,13·3%和14·4%。(5)原发性高血压患者的靶器官损害与危险因素的Lo-gistic回归分析显示血压分级和年龄是颈动脉增厚的决定因素、血压分级和体重指数(BMI)是左室肥厚的决定因素,年龄、血压分级、BMI和尿酸是肾功能损害的决定因素,年龄和血压分级是脑卒中的决定因素(P<0·05)。结论原发性高血压是高血压的主要病因。在继发性高血压中原发性醛固酮增多症的所占比例增加,动脉粥样硬化已成为肾血管性高血压的主要病因。超重与肥胖、糖脂、尿酸代谢异常仍是原发性高血压的主要危险因素。高血压住院患者中靶器官损害的发生率高,血压水平、年龄和BMI与EH的靶器官损害关系密切。

Objective To analyze the etiology and risk factors in-patients with hypertension from the department of hypertension in attempt to show the recent trend in hypertension. Methods Retrospective study was performed based on etiology and risk factors of in-patients with hypertension in department of hypertension. Results （1） Of 2 274 in-patients with hypertension, there were 86% of essential hypertension and 14% of secondary hypertension （SH）. Secondary hypertension comprised 51.3% of endocrine hypertension, 24.8 % of renovascular hypertension （ RVH ） and 22.3 % of renal hypertension. （ 2 ） The highest prevalence rate of secondary hypertension was primary aldosteromsm （ 40.2 %）. Main etiological factor of RVH was atherosclerosis. （ 3） To evaluate risk factors of EH： incidence of overweight and obesity, abnormality of glucose metabolism, hyperlipemia and hyperuricemia was 76.2%, 55.3%, 69.5 % and 31.7 %, respectively. （4） The occurrence rate of carotid artery thickness, left ventricular hypertrophy,chronic renal failure and stroke were 38. 1%, 26.2%, 13.3% and 14.4%, respectively. （5） Logistic regression shows that the grade of blood pressure and age were the 2 significantly independent determinants for carotid artery thickness; the grade of blood pressure and BMI were the significantly independent determinants for left ventricular hypertrophy. Age, grade of blood pressure, BMI and serum uric acid were significantly independent determinants for the lesion of kidney. Age and the grade of blood pressure were significantly independent determinants for stroke （P〈0.05. Conclusion The main etiological factor of hypertension was EH. In SH, the prevalence of PA was increasing and atherosclerosis was the main etiological factor of RVH. Overweight and obesity, lipid disorders, glucose and uric acid metabolism abnormalities were associated with increased risk of EH. The incidence rate of target-organ damage was high and it was closely related with age, the grade of blood pressure and BMI.