老年高血压患者左室肥厚及估算肾小球滤过率5年随访

Five-Year Follow-Up Data for Left Ventricular Hypertrophy and Estimated Glomerular Filtration Rate in Older Hypertensive Patients

目的:研究老年高血压患者治疗过程中左室肥厚(LVH)及估算肾小球滤过率(eGFR)5年间的变化情况。方法:选择在本科住院病史资料完整并随访5年及以上的老年高血压患者为研究对象,自2004年1月起在本科住院的老年高血压患者入院后均计算体质量指数,测血压、血糖、血脂、血肌酐、血尿酸、糖化血红蛋白、尿白蛋白/肌酐比值、肾小球滤过率、心电图及心脏彩超等。依尿白蛋白/肌酐比值、肾小球滤过率为指标将患者分为慢性肾脏病(CKD)组及非慢性肾脏病(NCKD)组。住院期间均选择以坎地沙坦为主的降压治疗措施,长期坚持上述方案治疗使病情控制达标,定期复查并随访5年以上;比较2组患者同一时间点相关指标,组内同一指标按不同随访时间进行比较。结果:2组间比较,各相同时间点对应的收缩压及舒张压差异无统计学意义,而左室质量指数(LVMI)、LVH及eGFR差异有统计学意义。同组内与基线水平比较,CKD组各时间点的收缩压、舒张压、LVMI、LVH及eGFR均明显改善,差异有统计学意义;NCKD组内除eGFR的变化无统计学意义外,其他指标变化情况与CKD组类似。结论:老年高血压患者中CKD及LVH的发生率较高。合理治疗能逆转LVH,保护肾功能。

Objective： To study changes of left ventricular hypertrophy （LVH） and estimated glomerular filtration rate （eGFR） in the process of therapy （5-year follow-up） in the elderly patients with hypertension. Methods：The elderly patients with hypertension, with full medical history and more than five-year follow-up, were included in this study. Values of body mass index （BMI）, blood pressure, blood sugar, blood fat, blood creatinine, uric acid, glycosylated hemoglobin, urinary albumin/ereatinine ratio, glomerular filtration rate, electrocardiogram and echocardiography were detected in patients admitted to hospital. Patients were divided into chronic kidney disease （CKD） group and non-CKD （NCKD） group according to urinary albumin/ereatinine ratio and glomerular filtration rate. The candesartan-based antihypertensive treatment was selected to control blood pressure. Patients were followed up for more than 5 years. The related indexes were compared at the same time points between groups. Results： There were no significant differences in systolic blood pressure and diastolic blood pressure in the same time points between two groups. There were significant differences in LVMI, LVH and eGFR. Values of systolic blood pressure, diastolic blood pressure, LVMI, LVH and eGFR were significantly improved after treatment compared with those of baseline levels in CKD group. There was no significant difference in clinical indicators in NCKD group except for eG- FR. Conclusion： The incidence of LVH and CKD were higher in elderly hypertensive patients. By means of reasonable treatment, LVH can be reversed and the renal function was protected.