单药治疗血压控制不良的单纯收缩期高血压患者的临床特征

Clinical characteristics of isolated systolic hypertensives with poorly controlled blood pressure by monotherapy

目的探讨单药治疗血压控制不良的单纯收缩期高血压（ISH）患者的临床特征。方法利用中国高血压控制现状调查（China Status）Ⅱ研究数据库中研究对象基线资料,进行ISH和非ISH患者的特征分析。结果符合入选条件的高血压患者11 312例中,ISH占20.54%,年龄30~80岁,ISH患者比例随年龄增长而增加。ISH组脉压大于非ISH组[（76.6±12.4）mm Hg比（60.9±12.0）mm Hg,P〈0.01]。ISH组常见合并症发生率较非ISH组高[合并冠状动脉性心脏病（冠心病）：ISH 25.1%比非ISH 12.9%;合并心力衰竭：3.3%比1.2%;合并脑卒中：10.4%比3.8%;合并慢性肾脏病：3.9%比2.9%;合并血脂异常：26.9%比22.9%;合并糖尿病：24.9%比14.0%;均P〈0.05]。其中,ISH组患者冠心病、心力衰竭和脑卒中的发生率约为非ISH组的2倍。年龄≥30岁,ISH患者的冠心病、心力衰竭、脑卒中和糖尿病的发生率随着年龄增长而增长。ISH组吸烟和饮酒患者比例低于非ISH组,但ISH组患者平均吸烟史和饮酒史显著长于非ISH组（均P〈0.01）。ISH组和非ISH组患者单药治疗以钙拮抗剂为主,换用单片复方制剂治疗的患者中,〉80%是因单药起始剂量治疗血压未达标。结论单药控制不良的ISH患者的比例随年龄增加而增加;ISH患者脉压大,合并症发生率高,吸烟史和饮酒史长。多数单药起始治疗患者因血压未达标而换用单片复方制剂治疗。

Objective To investigate the clinical characteristics of patients with isolated systolic hypertension（ISH）whose blood pressure（BP）was not adequately controlled by monotherapy. Methods Baseline data of participants from China StatusⅡ study database were used. These subjects were categorized into ISH and non-ISH（NISH）group. The characteristics of patients with ISH and NISH were compared. Results In 11 312 patients with hypertension,ISH accounted for 20.54%. Among the subjects aged from 30 to 80years old,the proportion of ISH patients increased with age. The pulse pressure in ISH patients was greater than that in NISH groups[（76.6±12.4）vs（60.9±12.0）mm Hg,P0.01]. The incidences of common complications were higher in ISH group than in NISH group [coronary heart disease（CHD）：25.1% in ISH vs 12.9% in NISH;heart failure：3.3% vs1.2%;stoke：10.4% vs 3.8%;chronic kidney disease：3.9% vs 2.9%;dyslipidemia：26.9% vs 22.9%;diabetes：24.9% vs 14.0%;all P0.05]. Among them,the prevalence of CHD,heart failure and stroke in ISH patients was nearly 2times than that of NISH group. The incidences of CHD,heart failure,stroke and diabetes increased with age in ISH patients≥30years old. The percentages of smoking and drinking were lower in ISH patients than in NISH subjects,but the average duration of histories of smoking and drinking in ISH group were significantly longer than that in ISH group（P0.01）. The calcium channel blockers in monotherapy predominated both in ISH and NISH group. Therapeutic regiments were changed to single-pill combination therapy in more than 80%of patients because of poorly controlled BP with monotherapy. Conclusion The occurrence of poorly controlled ISH by monotherapy increased with age. The ISH patients were characterized with higher pulse pressure,higher complication incidence and longer histories of smoking and drinking. Poorly controlled BP is the main reason for the change of therapeutic regiment from monotherapy to single-pill combination therapy.