高血压病患者的血浆肾素活性与脑钠肽水平及预后的关系

Relationship between plasma renin activity,brain natriuretic peptide level,and prognosis in patients with hypertension

目的观察具有不同血浆肾素活性的高血压病患者中血清脑钠肽(BNP)水平的差异,并随访12个月内的临床转归情况。方法将845例新发高血压病患者作为研究对象,对同一危险分层的患者根据血浆肾素差异按5分位法分取高肾素组和低肾素组,比较两组血清BNP水平的差异,并随访12个月内心脑血管事件的发生情况。结果低、中危高血压患者中血清肾素水平差异对血浆BNP水平和临床事件的影响甚微;高危患者中肾素活性的差异仅对BNP的影响具有显著性;极高危患者的高肾素组,其血浆BNP浓度和心脑血管事件(心肌梗死、不稳定型心绞痛、心源性猝死、心力衰竭、恶性心律失常、脑卒中)明显高于低肾素组。结论伴高肾素活性的极高危高血压病患者中血浆BNP水平升高,可能参与了高血压的靶器官损害,导致患者更容易发生心脑血管事件。

Objective To observe the difference of brain natriuretic peptide（BNP）level in hypertensive patients with various plasma renin activity,and to follow up the clinical outcome within 12 months. Methods Eight hundred and forty-five cases of new hypertensive patients as the research object. The patients on the same risk level were divided into high renin and low renin groups according by five points,the difference of BNP level between the two groups was compared,and cardiovascular events were followed up for 12 months. Results In low or moderate risk-patients with high blood pressure,plasma renin level difference had little impact on BNP concentration and clinical events. The differences of the renin activity among high-risk patients had a significant influence only on BNP level. The plasma BNP level and cardiovascular events （myocardial infarction,unstable angina,sudden cardiac death,heart failure,malignant arrhythmia,stroke） in high-rennin group were significantly higher than those in low-renin group. Conclusion Extremely high-risk hypertensive patients with high renin activity had higher BNP levels,which might participate in the target organ damage from hypertension,leading to more cardiovascular events.