青年高血压:病因学,靶器官损伤和治疗

Hypertension in Young Adult: Etiology, Targeted Organ Damage and Treatment

背景青年高血压可导致早发心脑血管疾病并增加死亡率和致残率。但在发展中国家,针对青年人高血压的研究尚少。亦没有专门针对青年人高血压患者的防治指南。方法:入选2002年至2008年于阜外医院就诊,年龄16-30岁之间,于门诊诊断为药物难治性高血压或者高血压原因待查的患者,回顾性分析这些患者的病因学特点,抗高血压药物的使用以及靶器官的损伤。结果:共有309例患者入选,其中原发性高血压患者占59.9%(185/309),继发性高血压患者占38.8%(120/309)。肾血管性高血压是继发性高血压最常见的原因,而大动脉炎是肾血管性高血压最常见的致病原因。在原发性高血压患者中,57.8%的患者合并一种以上的代谢综合症,较继发性高血压患者明显增多(9.2%,p<0.01),而两组患者靶器官损伤的比例没有显著差异(32.4%vs29.2%,p>0.05).药物抵抗性高血压高达55.7%(172/309)。继发性高血压,肥胖,利尿剂的使用不足是导致药物抵抗性高血压最常见的原因。结论:在小于30岁的青年高血压患者中,有一半以上的患者具有高血压的继发性因素,针对这些继发疾病进行积极地治疗可有效治愈青年患者的高血压。在青年原发性高血压患者中,代谢综合症包括肥胖,糖尿病,高脂血症的发病率很高,这加重了患者靶器官的损伤并导致药物抵抗性高血压的产生。

Backgrounds Hypertension in the young adult may lead to the early onset of cerebral cardiovascular disease and premature risk of death and disability, but it is poorly elucidated in developing countries. Methods We investigated the causal profi le, antihypertensive therapy in the patients younger than 16 to 30 years who were hospitalized with arterial hypertension in Fuwai hospital between 2002 to 2008. Results Totally 309 patients were enrolled. Essential hypertension and secondary hypertension were diagnosed in 59.9% （185/309） and 38.8% （120/309） respectively. Renovascular hypertension is the leading cause for secondary hypertension and Takayasu’s arteritis is the most common disease for renovascular hypertension. In Essential hypertensive, 57.8% of the patients presented with at least one component of metabolic syndrome, much higher than that in secondary hypertensives （9.2%, p0.01）, comparable in the targeted organ damage between essential and secondary hypertensives （32.4% vs 29.2%, p0.05）. Resistant hypertension was found in 55.7% （172/309） of the patients, secondary hypertension, obesity, underutilization of diuretics were the main causes for resistant hypertension. Conclusion We concluded that almost half young hypertensives can be identifi ed to have treatable causes for their hypertension. Young essential hypertensives have more frequent metabolic abnormalities which are the important contributors to hypertension and to resistant hypertension.