80岁以上老年高血压住院患者临床特点分析

Clinical characteristics of hypertension in patients aged over 80 years.

目的观察80岁以上老年高血压住院患者的临床特点和相关危险因素。方法选择2003年2月至2012年5月北京医院老年科和心内科住院的80岁以上的老年高血压患者336例，收集相关病史和临床资料，包括家族史、身高、体质量、诊室血压、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、肌酐、尿素、尿酸、尿蛋白等。结果80岁以上老年高血压患者以收缩压升高为主，脉压大，肾小球滤过率下降。336例患者中，脂代谢异常190例（56．5％），心房颤动45例（13．4％），慢性心功能不全66例（19．6％），微量蛋白尿53例（15．8％），冠心病139例（41．4％），脑血管病81例（24．1％）。男性（240例）和女性（96例）左心室肥厚分别为25例（10．4％）和22例（22．9％）；患糖尿病分别是111例（46．3％）和27例（28．1％），差异有统计学意义（7。值分别为8．91、9．38，均P〈O．01）。311例（92．6％）使用降压药治疗。使用利尿剂37例（11．9％），钙拮抗剂为182例（58．5％），血管紧张素受体拮抗剂89例（28．6％），血管紧张素转换酶抑制剂为68例（21．9％），G受体阻断剂为92例（29．6％），a受体阻断剂为31例（10．0％）。96例（30．9％）患者联合使用了他汀类调脂药，151例（48．6％）使用了抗血小板类药物。109例（35．0％）患者使用1种降压药，202例（65．0％）使用2种以上降压药。结论住院80岁以上老年高血压患者伴随多种危险因素和靶器官损害，多数患者使用两种或两种以上降压药治疗。

Objective To study the clinical characteristics and relative risk factors of hypertensive inpatients aged over 80 years. Methods From February 2003 to May 2012, 336 hypertensive inpatients aged over 80 years were enrolled in the study. Medical history and family history including height, weight, blood pressure, fasting glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, creatinine, urea nitrogen, uric acid and urine protein levels were reeorded and analyzed statistically. Results The elderly hypertensive inpatients over 80 years old had systolic hypertension with widening pulse pressure and the decline in glomerular filtration rate. The incidence of dyslipidemia, atrial fibrillation, microalbuminuria, coronary heart disease, cerebrovascular disease were 56.5 ~ （190/336）, 13.4 （45/336）, 15.8~ （53/336）, 41.4~/00 （139/336） and 24. 1~ （81/336）, respectively. Whereas there was no significant sex difference （PT〉0.05）. A significant difference was found in the incidence of left vetricular hypertrophy between males （10.4%, 25/240） and females （22.9%, 22/96） （2g2=8.91, P〈0.01）. The prevalence of diabetes in males （46.3%, 111/240） was significantly higher than in females （28.1%, 27/96） （Ze 9.38, P〈0.01）. From the 336 patients in the study, 311 （92.6%o） were treated by antihypertensive agents. The antihypertensive drugs included diuretics （37 patients, 11.9%）, calcium channel blocker （ 182 patients, 58.5%）, angiotensin receptor antagonists （ 89 patients, 28.6%）, angiotensin converting enzyme inhibitors （68 patients, 21.9%）, 13-blockers （92 patients, 29.6%）, α blockers （31 patients, 10.0%）, either alone （109 patients, 35.0%） or incombination （202 patients, 65.0%）. 96 （30.9%） patients were medically treated for dyslipidemia （drugs including statins）. 151 （48.6~） patients were treated with antiplatelet drugs. Conclusions The elderly hypertensive inpatients, over 80 years old, were accompanied by multiple risk factors and target organ damage, and most of them was treated with antihypertensive agents in combination.