原发性高血压患者心脏结构和功能改变的流行病学调查

Changes of Cardiac Structure and Function in the Hospitalized Patients With Essential Hypertension in Beijing

目的:了解北京市合并原发性高血压的住院患者心脏结构和功能改变的特点及相关因素。方法:针对北京地区4 081例原发性高血压住院患者进行流行病学回顾性调查,超声指标包括左心房及左心室内径,室间隔和左心室后壁厚度,E／A比值和左心室射血分数。其他指标包括患者的一般情况、病史和治疗情况。结果:高血压患者左心房扩大和E／A比值异常分别占所有患者的50．6％和70．0％,是高血压心脏损害最常见的两种表现。60～79岁老年人合并各种心脏结构和功能异常的比例均高于中年人。左心房扩大和左心室肥厚呈现出随血压水平升高,异常率增加的趋势。合并心脏结构和功能损害的高血压患者更多的使用联合用药。多因素分析显示,与左心房扩大有关的危险因素有合并心房颤动、肥胖、高龄、高血压病程长以及收缩压增高。与左心室肥厚有关的危险因素同样有高血压病程长、收缩压增高和高龄。与左心室扩大有关的危险因素有女性、合并心房颤动和肥胖。结论:①左心房扩大和E／A比值异常是高血压心脏损害最常见的两种表现;②老年人合并更多的心脏结构和功能损害;③血压水平越高,合并左心房扩大和左心室肥厚者越多;④男性、高血压病程长、收缩压增高和高龄是左心房扩大和左心室肥厚共同的危险因素,合并心房颤动患者合并更多的左心房扩大和左心室扩大。

Objective： To find out the echocardiographic characteristics of cardiac structure and function changes and its related factors in the hospitalized patients with essential hypertension in Belling. Methods ： This is an epidemiological retrospective survey performed in hypertensive patients in 20 hospitals in Belling. Echo- cardiographic results and clinical parameters were analyzed. Results： The echoeardiographic characteristics of all patients showed that the proportion of left atria enlargement and E/A abnormality were 50. 6% and 70. 0% respectively,which were the two most common cardiac abnormalities in hypertension. The elderly group （60-79 years old） complicated with more structural and functional damage than that in the middle-age group. The higher the blood pressure,the more patients complicated with the left atria enlargement and left ventricular hypertrophy. Patients with heart damages had been treated with more antihypertensive agents. The multiple-factor Logistic regression analysis showed that male, atrial fibrillation, obesity, aging, longer hypertensive history and elevated systolic blood pressure were the risk factors of left atria enlargement. The risk factors of left ventricular hypertrophy were male, longer hypertensive history, elevated systolic blood pressure and elder. The risk factors of left ventricular enlargement were female, atrial fibrillation and obesity. Conclusion ：①Left atria enlargement and E/A abnormality were two most common changes of cardiac abnormalities in hypertension. ②The elderly patients complicated with more cardiac structural and tunetional damages. ③The higher the blood pressure,the more patients complicated with the left atria enlargement and left ventricular hypertrophy. ④Male, longer hypertensive course, in-elevated systolic blood pressure and aging were common risk factors of left atria enlargement and left ventrieular hypertrophy. More patients with atrial fibrillation complicated with enlargement of left atria and left ventricle.