老年高血压病并发心脑血管事件患者的临床特点及遵循指南降压药物治疗现状

Clinical features and the status of antihypertensive treatment following the guide of the elderly hypertensive patients complicated by cardiovascular and cerebrovascular events

目的探讨老年高血压病并发心脑血管事件患者的临床特点及遵循指南降压药物治疗现状,减少高血压并发靶器官损害(TOD),提高老年人生存质量。方法对2010年1月—2011年1月在大连市沙河口区医院住院治疗老年(年龄≥65岁)高血压病并发心脑血管事件患者电子病例数据396例,分为脑卒中组和冠心病组,进行回顾性分析。对构成比、年龄、性别、血压、动态血压、心脑血管(TOD)及入院前后遵循指南使用降压药物品种比例和血压控制率等方面进行分析。结果 (1)基线资料:同组比较脑卒中组患者的男性构成比高于女性(P<0.01);冠心病组患者的女性构成比高于男性(P<0.05)。组间比较冠心病组患者患病年龄及1级高血压所占比例均高于脑卒中组(P<0.05);脑卒中组患者的男性构成比、3级高血压所占比例和诊室平均收缩压(SBP)均高于冠心病组(P<0.05)。(2)动态血压检测:两组患者中晨峰SBP≥35 mmHg 76.3%、SBP<35 mmHg 23.7%(P<0.01)。血压昼夜变化以夜间血压下降率表示,脑卒中组患者的夜间血压下降率<10%66.3%、10%～20%33.7%(P<0.01);冠心病组患者的夜间血压下降率<10%61.8%、10%～20%38.2%(P<0.05)。(3)心脑血管(TOD)患病率:脑卒中和冠心病患病率分别是79.5%和20.5%(P<0.01)。高血压TOD亚型分析显示,脑血管病以缺血性卒中患病率最高61.9%;冠心病患病率以缺血性心肌病最高31.9%。(4)遵循指南使用降压药物品种比例和血压控制率:入院前未用药物、1种、2种、≥3种分别为20.9%、36.4%、29.6%和13.1%。本组患病人群的知晓率42.3%、治疗率31.1%、控制率8.6%。入院后使用1种药物、2种、≥3种药物分别为13.1%、40.6%和46.3%。出院时(治疗2～3周)治疗者控制率23.1%。出院后继续用药1个月、3个月、6个月、9个月、12个月这部分人群血压控制率分别为23.3%、24.9%、29.8%、31.4%和34.3%(P<0.01)。结论老年高血压患者遵循指南按照危险分层使用降压药物后血压控制率较前明显提高,但按指南降压达标率尚有差距。

Objective Investigating the clinical characteristics and the status of antihypertensive drug treatment following the guide of the elderly patients with hypertension complicated by eardiovascular and cerebrovascular events, to reduce hypertension concurrent target organ damage （TOD） and improve the live quality of older persons. Methods During 01/2010 to 01/2011 in shahekou hospital of Dalian,396 cases of the ehlerly patients （ ≥65 years） with hypertension complieating cardiovascular and carebrovascular events were retrospectively analyzed, Ihey were divided into stroke group and coronary heart group. We analyses the constituent ratio, age, sex, blood pressure, ambulatory blood pressure, TOD of heart and brain, the varieties proportion of using the antihypertensive drug cand blood pressure control rates before and after hospitali- zation. Results （1） Baseline information： in the stroke group, men were more than women （P 〈 0.01 ） ; and in the CHD group,women were more than men （ P 〈 0.05 ）. Between the two groups the number of CHD group was higher than the stroke group in age and first - class high blood pressure, （ P 〈 0.05 ）. Stroke group was higher than the CHD group in the constituent ratio in men, third - class hypertension, the surgeries mean systolic blood pressure （SBP） （ P 〈 0.05）. （2） Ambulatory blood pressure monitoring： the SBP of the morning peak ≥35 mmHg 76.3% , SBP 〈 35 mmHg 23.7% （P 〈 0.01 ）. The circadian rhythm change was represented by declining in nocturnal blood pressure, the stroke group nocturnal blood pressure fell 〈10%, 66.3%; 10% -20% to 33.7% （P〈0.01）. CHD group 〈10% 61.8%, 10% -20% 38.2% （ P 〈 0.05 ）. （ 3 ） The prevalence of cardiovascular and cerebrovascular TOD ： the proportion of stroke and coronary heart disease were 79.6% , 20.4% （P 〈 0.01）. Hypertension the TOD subtype showed that ischemic stroke and cardiomyopathy were most up to 61.9% and 31.9%. （4）The varieties proportion of using the antihypertensive drug following the guide and blood pressure control rates：before admission, non - drugs used, 1 species, two species ≥ 3 species were 20.9%, 36.4% , 29.6% , 13.1% separately. Sicken people＇s awareness rate, cure rate and control rate was 42.3% , 31. 1% , 8.6% . Drugs used after admission, 1 species, two species ≥3 species were 13.1% , 40.6% , and 46.3% respectively. The control rate was 23.1% （ treating 2 - 3 weeks） when discharging from hospital. Keeping on medical care 1 month, 3 months, 6 months, 9 months, 12 months after discharge, The crowd＇s blood pressure control rate of this part were 23.3%, 24.9%, 29.8%, 31.4% , and 34.3% （P 〈 0.01 ）. Conclusion Stroke is a major cardiovascular risk for the elderly hypertensive patients. By hierarchically using the antihypertensive drug according to the risk following the guide, the blood pressure control rates of the elderly patients with hypertension improves, but there is still gap between the guide and practice in blood pressure control.