首次进入4500 m高原青年男性半年高血压发病情况及危险因素分析

Analysis of the prevalence and risk factors of hypertension in young men firstly entering the 4500 m plateau for half a year

目的研究首次暴露于海拔4500 m地区并停留半年时间的青年男性高血压发病情况及其危险因素。方法纳入由平原首次前往藏北海拔4500 m地区并停留半年时间的青年男性228例,根据血压情况分为高血压(HTN)组(n=66)与非高血压(NTN)组(n=162)。采用自制调查问卷、匹兹堡睡眠质量指数量表(PSQI)进行调查,并进行体格检查、实验室检测以了解高血压相关危险因素及伴随症状。采用多因素logistic回归分析高原高血压的危险因素及伴随症状的发生倾向。结果228例中青年男性66例发生高血压,发病率为28.9%,其中Ⅰ级高血压52例,Ⅱ级高血压14例;单纯舒张期高血压58例,收缩压合并舒张压升高8例。HTN组肥胖及超重、中心性肥胖、吸烟>10支/d、高血压家族史、血脂异常、高尿酸血症的比例明显高于NTN组(P<0.05),PSQI评分明显高于NTN组(P<0.001)。多因素logistic回归分析显示,高尿酸血症(P=0.02)、中心性肥胖(P=0.04)、高血压家族史(P=0.03)、PSQI评分(P<0.001)是高原高血压的独立危险因素。HTN组近1个月伴随不适症状的比例明显高于NTN组(P=0.001),伴随3种及以上不适的占比也高于NTN组(P=0.01),调整人口学差异后,HTN组伴随头晕及头痛的风险均高于NTN组(P<0.05)。结论青年男性首次暴露于4500 m地区半年时间仍伴有较高的高血压发病率,主要为Ⅰ级高血压且以舒张压升高为主;高尿酸血症、中心性肥胖、高血压家族史、睡眠质量差是高原高血压的独立危险因素;高原高血压易引起多种不适,且伴随头晕、头痛的风险较高。

Objective To investigate the prevalence and risk factors of hypertension in young men first exposed to high altitude for half a year at 4500 m.Methods A total of 228 young men who firstly traveled from a plain area to an altitude of 4500 meters in northern Tibet and stayed there for six months were recruited in present study.They were divided into hypertension group(HTN,n=66)and non-hypertension group(NTN,n=162)based on their blood pressure status.A self-administered questionnaire,the Pittsburgh Sleep Quality Index(PSQI),physical examinations and laboratory tests were used to investigate the risk factors and clinical complications of hypertension.The general data and clinical complications of the two groups were compared,and multivariate logistic regression was used to analyze the risk factors of high-altitude hypertension and predisposition of clinical complications.Results Among the 228 individuals,66 developed hypertension(incidence of 28.9%),including 52 cases of stageⅠhypertension and 14 cases of stageⅡhypertension.Fifty-eight individuals had isolated diastolic hypertension,and 8 individuals had combined systolic and diastolic hypertension.The proportions of obesity and overweight,central obesity,smoking over 10 cigarettes per day,family history of hypertension,dyslipidemia,and hyperuricemia were significantly higher in HTN group than those in NTN group(P<0.05).The PSQI score was also higher significantly in HTN group than that in NTN group(P<0.001).Multivariate logistic regression analysis showed that hyperuricemia(P=0.02),central obesity(P=0.04),family history of hypertension(P=0.03)and sleeping quality(P<0.001)were the independent risk factors for high-altitude hypertension.The proportion of clinical complications in the past month in HTN group was significantly higher than that in NTN group(P=0.001),and the proportion of three or more kinds of clinical complications was also higher in HTN group than that in NTN group(P=0.01).After adjusting for demographic differences,the risk of dizziness and headache in HTN group was higher than that in NTN group(P<0.05).Conclusions Young men firstly exposed to an altitude of 4500 meters still have a high incidence of hypertension after six months,mostly stageⅠhypertension with diastolic pressure elevation;Hyperuricemia,central obesity,family history of hypertension,and poor sleep quality are the independent risk factors for high-altitude hypertension.High-altitude hypertension can cause various clinical complications,and the higher risk of accompanying dizziness and headache.