老年人高血压的病因构成分析与靶器官损害探讨

Analysis of etiology and target organ damage in elderly patients with hypertension

目的 分析评估老年住院高血压患者的病因构成及靶器官损害情况. 方法 分析高血压科诊断明确的1 270例（年龄60～91岁）住院患者的病因分类及其合并靶器官损害的情况和特点. 结果 老年住院高血压患者中原发性高血压1 090例（85.8％）,继发性高血压180例（14.2％）;在继发性高血压中肾血管性高血压所占比例（67.8％）最高,其次为原发性醛固酮增多症（23.3％）;在1 090例原发性高血压患者中,有88.3％的患者存在靶器官损害或其他临床疾病.靶器官损害中颈动脉内膜增厚和左心室肥厚的检出率分别为66.6％和24.0％.在靶器官疾病中脑卒中、冠心病和慢性肾功能不全检出率分别为30.2％、26.7％和10.5％;原发性高血压患者的脑卒中、冠心病、慢性肾功能不全的检出率随年龄增加呈上升趋势（P＜0.05）,左心室肥厚和颈动脉增厚检出率在不同年龄组间无明显的变化趋势;慢性肾功能不全的检出率男性高于女性（P＜0.05）,但左心室肥厚、颈动脉增厚、冠心病、脑卒中在不同性别组间检出率差异无统计学意义（P＞0.05）. 结论 在老年住院高血压患者中继发性高血压主要是由于肾血管性高血压和原发性醛固酮增多症所致;而原发性老年高血压患者的靶器官损害较为普遍,在心、脑、肾三大靶器官疾病中以脑卒中检出率最高.

Objective To investigate the prevalence of target organ damage and analyze etiology in elderly hospitalized patients with hypertension.Methods A total of 1270 elderly inpatients aged 60 to 91 years from 2008 to 2012 were enrolled.This retrospective study was performed to analyze the etiology and the prevalence of target organ damage in hospitalized hypertensive patients.Results Among elderly hypertensive patients,secondary hypertension accounted for 14.2 % （180/1 270） while essential hypertension accounted for 85.8% （1 090/1 270）.In secondary hypertension,renovascular hypertension of atherosclerosis （67.8%） and primary aldosteronism （23.3%） had the higher prevalence rate.Among 1 090 hospitalized patients with essential hypertension,the prevalence of patients with ≥ 1 complications was 88.3 %.The prevalence of cerebrovascular disease,coronary heart disease and chronic renal failure were 30.2 %,26.7 % and 10.5 %,respectively.The occurrence rate of the increased carotid intima-media thickness and left type hypertrophy were 66.6 % and 24.0 %,respectively.The prevalence rate of cerebrovascular disease,coronary artery disease and chronic renal failure were increased with aging （P〈0.05）.Compared with female,male patients had a higher prevalence rate of chronic renal failure （P〈0.05）.Conclusions Secondary hypertension is mainly renovascular hypertension and primary aldosteronism in elderly patients with hypertension.And damage of target organ in elderly patients with primary hypertension is more common,highest with cerebral apoplexy among three target organs such as heart,brain and kidney disease.