原发性高血压患者不同体位血浆醛固酮浓度与脉压的相关性

Correlation between plasma aldosterone concentration and pulse pressure in patients with essential hypertension in different positions

目的探讨原发性高血压患者不同体位血浆醛固酮浓度(PAC)和脉压(PP)之间的相关性。方法连续选取2008年10月至2010年10月就诊于新疆维吾尔自治区高血压诊疗研究中心的高血压患者195例,所有受试者均成功完成立、卧、坐三体位刺激试验,分别测量三体位的血压和PAC。按照平均PP划分为正常PP组(PP<40 mm Hg)和PP增大组(PP≥40 mm Hg),比较2组间临床指标的差异,分析PP与醛固酮水平的相关性。结果 (1)不同PP水平的2组间比较,PP≥40 mm Hg患者平均血钾水平明显高于PP<40 mm Hg患者(P=0.01)。相关分析提示,矫正了血清钾、年龄、性别后,PP和直立位PAC(r=0.235,P=0.001)、坐位PAC(r=0.220,P=0.002)及仰卧位PAC(r=0.166,P=0.021)均存在正相关。(3)2组间比较显示,不管任何体位,PP≥40 mm Hg患者PAC明显高于PP<40 mm Hg患者。直立位和坐位PAC>12 ng/dl患者比PAC≤12 ng/dl患者平均PP更大。(4)以PP是否≥40 mm Hg作为因变量,年龄、血钾、体重指数及三体位的PAC为自变量分别建立Logistics回归模型,分析发现血清K^+[OR=0.043,95%CI:1.09(1.00~1.12)]以及PAC[OR=0.025,95%CI:0.35(0.13~0.88)]均为PP增大的风险因素。结论无论是立位、坐位还是卧位,血清PAC水平增高和PP增大有一定的相关性,提示较高水平的PAC是高血压患者动脉弹性下降的危险因素。

Objective To investigate the correlation between plasma aldosterone concentration(PAC)and pulse pressure(PP)in patients with essential hypertension in different positions.Methods A total of195patients with hypertension were selected at the Hypertension Center of People′s Hospital of Xinjiang Uygur Autonomous Region from October2008to October2010.All subjects successfully completed stimulation tests in the sitting,supine,and upright positions,and the blood pressure and PAC were measured in the three positions.According to the average pulse pressure,the patients were divided into either a normal PP group(PP<40mmHg)or a high PP group(PP≥40mmHg).Clinical indicators were compared between the two groups.The correlation between PP and aldosterone levels was analyzed.Results Serum potassium was significantly higher in the high PP group than in the normal PP group(P=0.01).Correlation analysis showed that after adjustment of serum potassium,age,and sex,PP was positively correlated with PAC in all the three positions(upright:r=0.235,P=0.001;sitting:r=0.220,P=0.002;supine:r=0.166,P=0.021).Regardless of any position,the level of aldosterone was significantly higher in the high PP group than in the normal PP group.Average PP was significantly higher in patients with PAC>12ng/dl in the upright and sitting positions than in those with PAC≤12ng/dl.A logistics regression model was established by using PP≥40mmHg as the dependent variable,and age,blood potassium,body mass index,and aldosterone levels in the three position as independent variables.Regression analysis showed that serum K+[OR=0.043,95%CI:1.09(1.00-1.12)]and PAC[OR=0.025,95%CI:0.35(0.13-0.88)]were risk factors for increased PP.Conclusion There is a positive correlation between serum PAC level and PP,regardless of body position.High level of PAC is a risk factor for arterial elasticity in patients with hypertension.