性别对高血压前期患者心脑血管疾病的影响

Impact of gender differences on dietary salt intake and coronary atherosclerosis in patients with prehypertension:a retrospective review

目的探讨不同性别对高血压前期患者的脑、冠状动脉粥样硬化的影响。方法收集心内科行冠脉造影检查(CAG)发现冠状动脉狭窄程度在30%~70%,仅接受药物治疗未行经皮冠脉介入(PCI)治疗的高血压前期患者243例,年龄在45~75岁,根据性别分为男性组140例和女性组103例,比较两组的临床特点、住院及访随期间用药情况,比较两组患者的高血压及心血管疾病(急性心肌梗死、缺血性脑卒中)发生情况。采用Cox多因素回归分析探讨年龄、性别、血脂等危险因素与高血压前期进展为高血压及心血管疾病发生的相关性。结果两组患者基线资料比较,女性组的年龄显著高于男性组[(61±7)岁vs.(59±7)岁,P<0.01],女性的血脂(总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)水平也显著高于男性患者(均P<0.01),但是男性患者的血肌酐值、左室舒张期内径及具有吸烟、饮酒史的比例显著高于女性患者(均P<0.01)。经3.1~8.7(中位数4.5)年的随访后发现高血压前期患者中男性组有71人(50.7%)进展为高血压,而女性组有52人(50.5%)进展为高血压,两组差异无统计学意义。心血管疾病方面,两组共计有72名患者发生急性心肌梗死,其中男性组心肌梗死发生率显著高于女性组(37.1%vs.19.4%,P<0.01),而女性组缺血性卒中发生率显著高于男性组(11.6%vs.4.3%,P<0.05),高盐饮食的亚组中男性组35人发生急性心肌梗死,女性组仅13人,其男性的心肌梗死发生率高于女性组(50.7%vs.25.5%,P<0.01)。为进一步探讨高血压及心血管疾病的危险因素,采用Cox多因素回归分析后发现,在高血压前期人群中,高盐饮食为高血压及心血管疾病独立的危险因素,高盐饮食为男性心血管疾病发生独立的危险因素(均P<0.05)。结论在高血压前期人群中,高盐饮食会加重高血压及心血管疾病的发生及进展,尤其是男性患者,男性高血压前期人群发生急性心肌梗死危险更高,而女性组中缺血性卒中发生率更高。

AIM To investigate the impact of gender differences on dietary salt intake and coronary atherosclerosis in patients with prehypertension. METHODS A retrospective review was performed on 243 prehypertension patients who underwent coronary angiography without percutaneous coronary intervention with the degree of coronary artery stenosis being 30%-70% from January 2003 to December 2009. Based on gender differences, all patients were sorted into male （n=140） and female groups （n=103）. Baseline clinical features were compares as well as laboratory data, information on drugs administered during hospitalization and during the follow up period, related risk factors, and incidence of hypertension and cardiovascular disease （including acute myocardial infarction and/or stroke） in the two groups. Cox regression analysis was utilized to measure the related risk factors of hypertension and cardiovascular disease. RESULTS The female group had a higher average age （61±7 versus 59±7, P〈0.01）, as well as blood lipids including total cholesterol, low density lipoprotein, high density lipoprotein, and cholesterol were higher than male patients （P〈0.01）. However, the male patient’s average serum creatinine values and left ventricular diastolic diameter were higher. The rate of somking and drinking history were higher in the male patients compared to female patients. After a median follow-up of 4.53 years （range, 3.1-8.7 years）, 71 （50.7%） male patients progressed to hypertension, but the women group had 52 （50.5%） patiens progress to high blood pressure. There were no statistical differences when comparing the two groups （50.7% vs. 50.5%, P〉0.05）. In terms of cardiovascular disease, 72 patients experienced acute myocardial infarction, including 52 male patients and 20 female patients. In the occurrance rate of myocardial infarction, the male group was higher than the female group （37.1% vs. 19.4%, P〈0.01）. The women group had an incidence of ischemic stroke greater than the men group （11.65% vs. 4.28%, P=0.03）. In the subgroup of high dietary salt intake, 35 patients in the men group had acute myocardial infarction, while compared with only 13 patients in the female group. Incidence of acute myocardial infarction was higher in the male group compared with females （50.7% vs. 25.5%, P〈0.01）. To further explore risk factors of hypertension and cardiovascular disease, Cox multiple factors regression analysis revealed that a diet of high salt intake was an independent risk factor for hypertension and cardiovascular disease, especially in male prehypertension （P〈0.05）. CONCLUSION In prehypertension patients, a diet of high salt intake increases incidence of hypertension and cardiovasculr disease. The occurrance rate of myocardial infarction was higher in the male group compared to females; however, the incidence of ischemic stroke was higher in the women group.