难以控制的高血压628例病因分析

Etiology analysis of 628 patients with refractory hypertension

目的了解难以控制的高血压患者病因构成及其在不同性别和年龄中的分布特点。方法采用回顾性研究方法，分析近8年来在新疆维吾尔自治区人民医院高血压专科住院的628例难以控制的高血压患者的病因分类及其在不同性别和年龄段中的分布情况。结果（1）628例难以控制的高血压患者中原发性高血压占80.1％（503／628），继发性高血压占18.9％（119／628），病因待定者占1.0％（6／628）；在继发性高血压中，肾血管性高血压和睡眠呼吸暂停综合征所占比例较高，分别为33.6％和23.5％；在内分泌性高血压中，原发性醛阿酮增多症所占比例最高（13.5％）。（2）在难以控制的高血压患者中男性多于女性，原发性高血压、继发性高血压、肾实质性高血压、睡眠呼吸暂停综合征、原发性醛固酮增多症男性所占的比例都高于女性；嗜铬细胞瘤女性的比例高于男性；肾血管性高血压男女所占比例相同。（3）难以控制的继发性高血压在青年中所占比例最大（33.1％），老年人中所占比例最小（13.8％）。结论本组难以控制的高血压患者中，原发性高血压占比例最高；在继发性高血压中，肾血管性高血压和睡眠呼吸暂停综合征所占比例较高；内分泌性高血压中，原发性醛固酮增多症所占的比例最高；青年患者所占比例显著大于老年人。

Objective To analyze the etiology of 628 patients with refractory hypertension and to observe the disease distribution with respect to gender and different age groups. Methods In this study, clinical data of 628 refractory hypertensives who hospitalized in our hospital from September 1997 to December 2005 were retrospectively analyzed. Results（1） There were 80.1%（503/628） patients with essential hypertension, 18.9% （119/628） with secondary hypertension （SH） while diagnosis was not clear in 1.0% （ 6/628） patients. Renovaseular hypertension （ 33.6% ） and obstructive sleep apnea syndrome （23.5%） were the major causes of SH. The highest prevalence rate of endocrine hypertension was primary aldosteronism （13.5%）. （2） There were significantly more male patients than female patients with essential hypertension, SH, renal hypertension, obstructive sleep apnea syndrome, primary aldosteronism while the incidence of pheochromocytoma in female was significantly higher than that in male patients （ all P 〈 0. 05 ）. The incidence of renovascular hypertension was similar between male and female patients. （3） SH occurred more often in young patients （33.1%） than in aged patients （13.8%, P〈0.05）. Conclusion Our data from this patient cohort showed that SH, especially renovaseular hypertension and obstructive sleep apnea syndrome are major causes for refractory hypertension in young patients and primary aldosteromsm was the commonest reason of endocrine hypertension in youth and middle-aged patients with refractory hypertension.