脉压、脉压指数及估算肾小球滤过率在高血压患者中的应用

Clinical value of pulse pressure,pulse pressure index and estimated glomerular filtration rate in patients with essential hypertention

目的探讨高血压患者脉压(PP)与脉压指数(PPI)在预测高血压患者肾功能受损中的作用,分析冠心病患病率在不同PP、PPI及估算肾小球滤过率(eGFR)分组中的差别。方法742例高血压患者分别按照PP(≤55 mmHg与>55 mmHg)和PPI(≤0.45与>0.45)进行分组,观察各组eGFR值的变化及其与PP、PPI的相关性;分析根据不同eGFR、PP和PPI分组时冠心病的患病率情况。结果PP>55 mmHg组和PPI>0.45组的eGFR值均明显低于PP≤55 mmHg组和PPI≤0.45组(P<0.01)。控制年龄、体质量、体质量指数(BMI)、血红蛋白和舒张压因素后,偏相关分析结果显示,eGFR与PP(r=-0.279,P<0.01)、PPI(r=-0.364,P<0.01)仍呈弱负相关。eGFR<60 mL/min组、PP>55 mmHg组和PPI>0.45组的冠心病患病率分别为20.9%、18.5%和20.4%,均较其相应对照组明显增高(均P<0.05)。结论高血压患者随着PP和PPI的增高,eGFR值呈显著下降趋势,而冠心病患病率则明显上升。提示当PP>55 mmHg、PPI>0.45及eGFR值出现轻中度下降时,可能是老年高血压患者罹患冠心病的危险因素。

Objective To explore the predictive value in patients with essential hypertention of pulse pressure （PP） and pulse pressure index （PPI） on the renal impairment and to compare the prevalence of coronary heart disease （CHD） in subgroups divided by PP, PPI and estimated glomerular filtration rate （eGFR）. Methods A total of 742 patients with essential hypertention were divided according to PP（ ~〈 55 mmHg or 〉 55 mmHg）and PPI（ ≤0.45 or 〉 0. 45 ） respectively to compare the differences of eGFR and its relationship with PP and PPI. The prevalences of CHD in the subsets of PP, PPI and eGFR were also investigated. Results eGFR was significantly lower in PP 〉 55 mmHg and PPI 〉 0.45 groups than corresponding PP≤55 mmHg and PPI ≤0.45 groups （P 〈 0.01 ）. After adjustment for age, weight, body mass index（BMI） , hemoglobin and diastolic blood pressure, there was still a weak correlation in eGFR with both PP（r = -0. 279, P 〈 0.01 ）and PPI（ r = -0. 364, P 〈 0.01 ）. The prevalences of CHD were significantly increased in the groups of eGFR 〈 60 ml/min, PP 〉 55 mmHg and PPI 〉 0.45 （20.9% , 18.5% and 20.4% , respectively） than the corresponding controls （ P 〈 0.05 for all）. Conclusion With the elevation of PP and PPI, eGFR is significantly decreased and the prevalence of CHD is significantly increased in patients with essential hypertention. It is suggested that PP 〉 55 mmHg, PPI 〉0.45 and mild to moderate decrease of eGFR may be risk factors for CHD in senile patients with essential hypertension.