北京住院高血压患者心脏结构功能及治疗达标情况的分析

Retrospective survey on clinical characteristics and therapy management for hospitalized patients with essential hypertension in Beijing

目的回顾性分析北京市三级医院住院的高血压患者的心脏结构功能改变的相关因素,为临床治疗提供依据。方法采用回顾性调查的方法,通过超声诊断技术分析高血压患者的心脏结构及功能的参数,并对患者的年龄、血压水平、合并的危险因素及疾病、降压药物使用情况进行相关分析。结果共分析住院的原发性高血压患者5106例,平均年龄63.78岁,平均血压145.97/84.23mm Hg(1 mm Hg=0.133 kPa)。75.5%的患者至少合并一种心血管危险因素,随着血压水平的升高,合并左心室肥厚的患者比例明显增高。有近30%的患者合并不同程度的心功能不全。调查中发现,左房扩大和左心室舒张功能不全是高血压患者最常见的心脏损害。多因素分析显示,较高的收缩压、舒张压、血肌酐水平、老年和低高密度脂蛋白胆固醇是高血压合并左心室肥厚的危险因素。所有患者血压达标率(血压<140/90 mm Hg)为32.1%,单药治疗达标率为38.1%。钙拮抗剂和利尿剂是使用最多的两类降压药。结论要重视血压的治疗达标和多重危险因素共同干预以延缓或逆转高血压心脏损害的发生发展,原发性高血压的防治仍任重而道远。

Objective To evaluate the clinical characteristics and therapy conditions in hospitalized patients with essential hypertension in Beijing. Methods Patients with essential hypertension hospitalized in 20 Beijing hospitals in recent 2 years were included in this epidemiologic retrospective survey. Data on age, blood pressure level, risk factors and complicated diseases, antihypertensive medication and heart structural and functional characteristics measured by echocardiography were collected. Results Total 5106 hospitalized patients （mean age 63.78 years ） with essential hypertension were recorded. Mean blood pressure was 145. 97/84. 23 mm Hg（ 1 mm Hg =0. 133 kPa）. Among them, 75. 5% complicated with at least one risk factor, 30% suffered from heart failure. The atria enlargement and left ventricular diastolic dysfunction were the two most common echocardiographic pathological changes. Left ventricular hypertrophy is positively correlated with blood pressure. Logistic regression analysis showed that increased systolic blood pressure, diastolic blood pressure and plasma creatinine, old age and decreased HDL-cholesterol were risk factors of left ventricular hypertrophy. Only 32. 1% patients achieved the goal blood pressure level （ 〈 140/90 mm Hg） and 38. 1% patients were treated with monotherapy. The most commonly used antihypertensive drugs were calcium channel blockers and diuretics. Conclusions It is of importance to strictly follow the therapy guidelines on hypertension treatment and use combined drug therapy to increase the rate of patients reaching goal blood pressure level and reduce hypertensive complications.