青年高血压患者临床特征分析

Clinical Characteristics of Hypertension in Hospitalized Young Adults

背景青年高血压发病率逐年上升,但对于青年高血压人群的认识和重视不足,目前尚无专门针对青年高血压的防治指南。目的了解青年高血压患者的临床特征,为青年高血压早期诊断和治疗提供建议与参考。方法选取2016-2017年在阜外医院高血压中心因高血压首次住院、年龄≤35岁的患者875例为研究对象。收集患者一般临床资料、病因类型、并发症及靶器官损伤相关指标。结果共入组875例青年高血压患者,其中原发性高血压624例(71.3%),继发性高血压251例(28.7%)。原发性高血压中男性患者451例(72.3%),继发性高血压中男性患者168例(66.9%)。251例青年继发性高血压中最常见病因为阻塞性睡眠呼吸暂停(OSA),随后依次为肾血管性高血压(RAS)、原发性醛固酮增多症(PA)、主动脉狭窄、多囊卵巢综合征及肾实质性高血压,其他少见病因包括甲状腺功能异常、库欣综合征、Liddle综合征及嗜铬细胞瘤。与原发性高血压相比,继发性高血压入院血压高,并发肾功能不全、心力衰竭、主动脉夹层、外周动脉狭窄/闭塞比例高,差异有统计学意义(P<0.05)。结论原发性高血压是青年高血压的主要病因,男性患者多见,接近1/3的患者具有高血压的继发性因素,OSA、RAS、PA是继发性高血压三大主要病因。继发性高血压较原发性高血压患者血压水平高、靶器官损伤重。

Background Annual hypertension incidence is increasing in young adults.However,due to inadequate identification of and insufficient attention paid to this group,there are no guidelines for the prevention and treatment of hypertension in this group.Objective To examine the clinical characteristics of hypertension in young adults,providing suggestions and references for early diagnosis and treatment of hypertension in this group.Methods We enrolled 875 young adults( ≤ 35 years old) who were initially hospitalized for hypertension from Hypertension Center,Fuwai Hospital from 2016 to 2017.We collected their clinical data,etiological types,complications and indicators of target organ damage.Results Of the participants,624(71.3%) had essential hypertension,and 451(72.3%) of them were men.251(28.7%) had secondary hypertension,and 168(66.9%) of them were men.Obstructive sleep apnea(OSA) was the most common cause of secondary hypertension in 251 young adults, followed by renal artery stenosis(RAS), primary aldosteronism(PA), aortic stenosis, polycystic ovary syndrome and renal parenchymal hypertension. Other rare causes included thyroid dysfunction, Cushing’s syndrome, Liddle’s syndrome and pheochromocytoma.Compared with those with essential hypertension,secondary hypertension patients had higher mean admission blood pressure levels,and higher rates of renal insufficiency,heart failure,aortic dissection,and peripheral arterial stenosis/occlusion(P<0.05).Conclusion Essential hypertension is more common in young hypertensive adults,especially in males.Nearly one third of them have factors that can lead to secondary hypertension,among which OSA,RAS,and PA are three major ones.Secondary hypertension patients have higher admission blood pressure and more severe target organ damage than those with essential hypertension.