观察无自觉症状高血压人群未接受规范化治疗的病情进展

Observation of Progression of Asymptomatic Hypertension without Standard Management

目的:探讨无自觉症状高血压人群未接受规范治疗所产生心脑肾靶器官的影响。方法:选取于我院初诊为原发性高血压但本身没有高血压相关症状,且依从性差未接受高血压规范治疗的58例患者作为未规范治疗组(A组),对照组(B组)为62例相同病情的高血压人群,接受了高血压规范治疗。随访时间6年。比较患者入组时及6年复诊结束时左心室射血分数(LVEF)、左心室后壁厚度(LVPW)和室间隔厚度(IVS)、血清β2-微球蛋白(β2-MG)、颈动脉粥样斑块及出现心脑血管事件(脑卒中、心绞痛、急性左心衰等)所出现的变化。结果:两组患者均随访6年。观察初诊及复诊6年后,两组患者各自LVEF、LVPW、β2-MG、颈动脉粥样斑块、心脑血管事件依次为(65.3±3.0)%及(42.3±3.0)%(P<0.05),(67.8±2.8)%及(64.8±4.8)%(P>0.05);(9.5±0.9)mm及(11.5±0.8)mm(P<0.05),(9.8±0.6)mm及(10.1±0.2)mm(P>0.05);(1.4±0.2)mg/L及(5.4±0.2)mg/L(P<0.05),(1.3±0.3)mg/L及(1.8±0.2)mg/L(P>0.05);20.69%及43.10%(P<0.05),20.97%及25.81%(P>0.05);8.62%及27.59%(P<0.05),6.45%及9.68%(P>0.05)。结论:无自觉症状高血压人群未接受规范治疗,引起心脑肾靶器官损害及心脑血管事件明显高于接受规范治疗人群,积极进行规范的医疗干预能延缓病情发展。

Objective： To evaluate the influence of target organ damage to cardio-cerebral-vascular system and kidneys about asymptomatic hypertension without standard management. Methods： A cohort study was conducted among 120 patients with asymptomatic hypertension. Patients divided into group A （no standard management and also poor com- pliance in primary diagnosis,n=58 ） and group B （standard management,n=62）. The follow-up period was six years. The left ventricular ejection fracion （LVEF）, the left ventrieular posterior wall thickness （LVPW）, the interventrieular septal thickness（IVS） were mesasured echocardiographically. The serum concentration of 132-MG was measured by rate nephelometry assay. And the risk of Carotid atheromatous plaque measured by ultrasonic artery examination and cardiovascular events（stroke,angina and acute left heart failure, etc）. Results： By comparing outcomes of those of the end of follow-up periond in group A and B showed that： it was significantly reduced in LVEF[（ 65.3±3. 0）% VS （42. 3±3.0） %（P〈0.05）], significantly increased in LVPW[（9. 5±0. 9）mm VS （11.5±0. 8）mm（P〈0. 05）] ,132-MG[（1.4±0. 2）mg/L VS （5.4±0. 2）mg/L（P〈0. 05）], carotid atheromatous plaque[20. 69% VS 43.10% （P〈0. 05）],and cardiovascular events[8. 62% VS 27. 59%（P〈0. 05）]. There was no difference in LVEF（67. 8±2. 8）% VS （64. 8±4.8）%（P〉0. 05）, LVPW[（9.8±0. 6）mm VS （10. 1±0. 2）mm（P〉0. 05）],β2-MG[（1.3±0. 3）mg/L VS （1.8±0. 2）mg/L（P》0. 05）], carotid atheromatous plaque[20. 97% VS 25.81% （P〉0. 05）], cardiovascular events[6.45% VS 9.68 % （P》0. 05）]. Conclusion： Asymptomatic hypertension without standard management in resulting in the risk of target organ damage to cardio-cerebral-vascular system and kidneys is significantly increased more than those of standard management, and standard management can delay progress of the disease.