伴高同型半胱氨酸的老年女性高血压急症患者叶酸治疗的5年预后

Outcomes in elderly female emergency hypertensive patients with hyperhomocysteinemia after 5 years of folic acid treatment

目的研究伴高同型半胱氨酸(Hcy)老年女性高血压急症患者叶酸治疗的5年预后。方法入选伴高Hcy(>10μmol/L)血症的老年女性高血压急症患者319例,随机分低剂量组(叶酸0.4mg/d)159例和高剂量组(叶酸0.8mg/d)160例。嘱患者规律服药降压治疗,补充叶酸。出院后通过复诊或电话随访5年,记录相关事件,并进行分析。结果随访5年结束时,高剂量组缺血性脑卒中入院发生率明显低于低剂量组(41.0%vs 54.4%,P=0.02)。高剂量组直立性低血压发生率明显低于低剂量组(45.8%vs 68.4%,P=0.00)。高剂量组较低剂量组降低23.5%的缺血性脑卒中再住院发生率(P=0.021)。结论在稳定降压、限钠、补充维生素B12的基础上,补充叶酸0.8mg/d可更好的预防老年女性高血压急症患者的心脑血管事件。

Objective To study the clinical characteristics of elderly female emergency hypertensive patients with hyperhomocysteinemia and their outcomes after 5 years of folic acid treatment.Methods Three hundred and nineteen elderly female emergency hypertensive patients with hyperhomocysteinemia （〉10 μmol/L） were randomly divided into low folic acid dose （0.4 mg/d）treatment group （n=159） and high folic acid dose （0.8 mg/d） treatment group（n=160）.The patients were treated with hypotensors.The patients were followed up for 5 years after they were discharged,during which the cardiovascular and cerebrovascular events were recorded and analyzed.Results The incidence of ischemic stroke was significantly higher while that of orthostatic hypotension was significantly lower in high folic acid dose treatment group than in low folic acid dose treatment group at the end of 5-year follow-up （41.0% vs 54.4%,P=0.02; 45.8% vs 68.4%,P=0.00）.The readmission rate due to ischemic cerebrovascular disease was significantly lower in high folic acid dose treatment group than in low folic acid dose treatment group （P =0.021）.Conclusion Folic acid （0.8 mg/d） can effectively prevent cardiovascular and cerebrovascular events in elderly famale emergency hypertensive patients by stabilizing their blood pressure,limiting their salt intake,and supplementing vitamin B12.