老年高血压患者的血压控制现状及影响因素分析

Blood pressure control situation and influential factors in aged hypertension patients

目的分析老年高血压患者的血压控制现状及影响因素,指导老年高血压患者的综合防治。方法回顾性分析老年高血压患者2593例,依据血压控制情况分为血压控制正常组(853例)和高血压组(1740例)。所有患者均进行了超声心动图检查,测定左心室二尖瓣舒张早期血流峰值(E)和舒张晚期血流峰值(A)比值(E/A)及LVEF等指标。结果2 593例老年高血压患者服药率和血压控制率分别为94.4%、32.9%。6种常用的降压药物中应用较多的是利尿剂、钙离子拮抗剂、血管紧张素Ⅱ受体拮抗剂和血管紧张素转换酶抑制剂。1988例(76.7%)合并有吸烟史、血脂异常、高血压家族史、肥胖等危险因素。超声心动图检查心脏收缩功能异常率17.2%、E/A比值异常率27.6%。单因素及多因素logistic回归分析,血压控制正常组和高血压组动脉粥样硬化、冠心病、体重指数、TC、HDL-C和左心室后壁等6项指标差异有统计学意义。结论老年高血压患者血压的控制并未有随着服药数量的增加而改善。应该对合并的危险因素及临床情况、生化指标及心脏的结构和功能异常等进行综合防治。

Objective To analyze blood pressure control situation and influential factors in aged hypertension patients and evaluate the therapeutic efficacy in order to guide the comprehensive control of hypertension in aged patients. Methods 2 593 aged hypertension patients were analyzed retrospectively and divided into normal blood pressure and high blood pressure groups according to the control of blood pressure level. Echocardiography examination was performed to appraise cardiac structure and function. Results The medication rate in 2 593 aged hypertension patients was 94.4% and the blood pressure control rate was 32.9%. Diuretics,calcium antagonists,angiotensin receptor antagonists and angiotensin converting enzyme inhibitors were commonly used. 1 988（76.7%） patients had one or more risk factors such as family hypertension history, smoking, blood lipid abnormality and obesity. The rate of left ventricle systolic dysfunction and rate of abnormal E/A ratio were 17.2% and 27.6% respectively. Among the concomitant diseases and risk factors,atherosclerosis, coronory artery disease, body mass index, TC, HDL-C and left ventricular posterior wall were different statistically between normal blood pressure and high blood pressure groups. Conclusion Aged hypertension patients had high medication rate and low blood pressure control rate. The comprehensive control of hypertension should include the treatment of risk factors, clinical disease, blood-lipid abnormality, abnormal cardiac structure and function.