老年高血压合并代谢异常特征及其对靶器官的影响

Characteristics of metabolic disorders and their effects on target organ damage in elderly patients with hypertension

目的分析老年原发性高血压患者合并不同代谢异常的临床特征及其对靶器官的影响。方法选择老年高血压患者460例,根据合并代谢异常情况分为6组:A组(单纯高血压,21例),高血压合并腹型肥胖、血脂异常、糖尿病、高尿酸血症及代谢综合征分别为B组(32例)、C组(73例)、D组(54例)、E组(27例)和F组(253例),行相关生化指标检测和超声等检查,综合评估其靶器官损害和并发症情况。结果单纯高血压患者仅占4.6%,95.4%的患者合并1项以上代谢异常。与A组比较,F组体重指数、腰围、空腹血糖、餐后2 h血糖、糖化血红蛋白、TG、尿酸及血肌酐明显升高(P<0.05),HDI-C明显下降(P<0.05);各组高血压病程和血压控制水平相当,但F组较其他组需要多种的抗高血压药物(P<0.05);D组与F组颈动脉内膜中层厚度、尿微量白蛋白/肌酐以及合并冠心病和脑血管病差异有统计学意义(P<0.05)。结论老年高血压患者以多重代谢性危险因素聚集为特征,该特征使靶器官损害和心脑血管病的发生明显增加,且需要多种抗高血压药物联用以控制血压。

Objective To assess the characteristics of metabolic disorders and their effects on target organ damage in elderly patients with hypertension. Methods 460 treated elderly patients with hypertension were divided into six groups： hypertension without complications（group A, 21 ca- ses）, hypertension with abdominal obesity （group B, 32 cases）, hypertension with dyslipidemia （group C,73 cases）,hypertension with type 2 diabetes mellitus（group D, 54 cases）,hypertension with hyperuricemia（group E,27 cases） and hypertension with metabolic syndrome（group F, 253 cases）. Blood pressure, serum biochemical indexes and urinary microalbuminuria were determined. And the structure and function of heart and carotid artery were examined by ultrasonogray in order to evaluate the damage of target organ and the morbidity. Results Among the elder- patients,only 4.6% had no additional metabolic disorder except for hypertension,and 95.4% pertensives complicated with one or more metabolic disorders. All the levels of BMI, waistline, triglyceride, fasting plasma glucose, postprandial plasma glucose, glycosylated hemoglobin, serum uric acid and serum creatine in group F were significantly higher than those in group A（P〈0.05）,but that of HDL-C in group F was significantly lower than in group A. Group D and F showed that the medial thickness of carotid artery intima, the ratio of microalbuminuria to creatine,and incidence of coronary heart disease and cerebrovascular disease were all higher than those in group A（P〈0.05）. Conclusions These results suggest that most elderly patients with hypertension are complicated with additional metabolic disorders and the patients with clustering risk factors reguired a greater number of antihypertensive drugs. The more additional metabolic disorders exist,the higher the incidence of target organ damage and the morbidity are.