421例老年高血压住院患者危险因素及其对靶器官损害的回顾性分析

Retrospective analysis on the risk factors and their effects on target organ damage of 421 elderly hypertensive inpatients

目的分析老年高血压患者多重危险因素的聚集和其对靶器官损害的特征。方法选择老年高血压患者421例,根据合并危险因素的个数分为:A组(单纯高血压)25例。高血压合并1、2、3及大于或等于4项危险因素分别为B组76例、C组127例、D组128例和E组65例,综合评估危险因素及其对靶器官损害的情况。结果与A组比较,D、E组患者体质量指数(BMI)、血糖、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肌酐(Scr)、尿酸(Uric)等指标明显升高(P<0.05),且需要更多的降压药物种类(P<0.05);C、D、E组患者左心室重量指数(LVMI)、颈动脉内膜中层厚度(IMT)和尿微量清蛋白/肌酐比值较A组均明显升高(P<0.05),内生肌酐清除率明显下降(P<0.05),并发冠心病、脑血管病和慢性肾脏疾病的发生率较A组明显增加(P<0.05)。结论老年高血压患者以多重危险因素聚集为特征。危险因素越多,靶器官损害和并发症的发生越多。需要更多抗高血压药物联合应用以控制血压。

Objective To assess the clustering of cardiovascular risk factors and their effects on target organ damage in elderly patients with hypertension .Methods 421 treated elderly hypertension patients were divided into 5 groups based on the number of risk factors ：hypertension without additional risk factor （group A ,25 cases） ,and the other 4 groups were complicated with 1 （group B ,76 cases） ,2（group C ,127 cases） ,3（group D ,128 cases）and ≥ 4 （group E ,65 cases） risk factors .The structure and function of heart and carotid artery were examined by ultrasonography in order to evaluate the damage of target organ and the morbidity .Re-sults The patient groups with three or more risk factors showed significantly higher levels of BMI ,plasma glucose ,triglyceride , LDL-C cholesterol ,serum creatinine and serum uric acid ,and needed greater number of antihypertensive drugs ,compared with other groups（P〈0 .05） .The patient groups with two or more risk factors showed significantly higher levels of LVMI ,IMT and MAU/Cr compared with group A（P〈0 .05） ,and significantly lower levels of the creatinine clearance （P〈0 .05） .In addition ,they showed significantly higher incidences of coronary heart disease and cerebrovascular disease and chronic kidney disease compared with group A （P〈0 .05） .Conclusion These results suggest that the hypertensive patients with clustering risk factors required greater number of antihypertensive drugs .The more additional risk factors exit ,the more target organ damages and higher morbidity occur ,and more intensive intervension are required to control not only blood pressure but also other complicated risk factors .