氢氯噻嗪片对盐敏感性高血压患者血压达标率及预后的影响

Effect of hydrochlorothiazide tablet on the blood pressure standard-reaching rate and prognosis of patients with salt-sensitive hypertension

目的:探究氢氯噻嗪片对盐敏感性高血压(SSHT)患者血压达标率及预后的影响。方法:选择符合入选标准的原发性高血压患者2114例,通过冷加压试验筛查出SSHT患者734例,随机分为对照组(n=367,降压方案中未使用利尿剂)和实验组(n=367,降压方案中包括氢氯噻嗪),治疗3个月后随访6个月。根据随访6个月后的血压达标情况,分为血压达标组(n=323)和血压不达标组(n=411)。比较对照组和实验组基本资料和预后情况,以及血压达标与不达标组临床资料。结果:本研究734例SSHT患者中,高钠饮食者323例(44.01%)。Pearson相关分析显示,SSHT患者尿钠/尿钾比值与收缩压、舒张压呈显著正相关(r=0.146,P=0.001;r=0.135,P=0.008)。实验组血压达标率显著高于对照组(47.7%比40.3%),P=0.045。与血压达标组比较,血压不达标组男性(46.1%比57.4%)、超重或肥胖(38.4%比51.1%)、糖尿病(24.1%比33.3%)、血肌酐升高(38.1%比49.6%)、高脂血症(38.7%比48.9%)、高钠饮食(37.5%比49.1%)的比例显著升高,使用氢氯噻嗪片的比例(54.2%比41.4%)显著降低(P<0.05或<0.01),提示使用氢氯噻嗪患者血压更易达标。结论:规范使用氢氯噻嗪片可显著提高盐敏感性高血压患者的血压达标率。

Objective:To investigate the influence of hydrochlorothiazide tablet on blood pressure standard-reaching(BPSR)rate and prognosis in patients with salt-sensitive hypertension(SSHT).Methods:A total of 734 SSHT patients were screened through cold pressor test from 2114 eligible patients with primary hypertension.They were randomly divided into control group(n=367,received antihypertensive program without diuretic)and experimental group(n=367,received antihypertensive program with hydrochlorothiazide),both groups were treated for 3 months and then followed up for 6 months.According to BPSR condition after six-month follow-up,they were divided into BPSR group(n=323)and no BPSR group(n=411).Baseline data and prognosis between control group and experimental group,clinical data between BPSR group and no BPSR group were compared.Results:Among the 734 SSHT patients,there were 323 patients(44.01%)with high sodium diet.Pearson correlation analysis indicated that urine sodium/potassium ratio was significant positively correlated with systolic blood pressure and diastolic blood pressure in SSHT patients(r=0.146,P=0.001;r=0.135,P=0.008).BPSR rate of experimental group was significantly higher than that of control group(47.7%vs.40.3%),P=0.045.Compared with BPSR group,there were significant rise in percentages of men(46.1%vs.57.4%),overweight or obesity(38.4%vs.51.1%),diabetes mellitus(24.1%vs.33.3%),elevated serum creatinine(38.1%vs.49.6%),hyperlipidemia(38.7%vs.48.9%)and high sodium diet(37.5%vs.49.1%),and significant reduction in percentage of hydrochlorothiazide tablet usage(54.2%vs.41.4%)in no BPSR group,suggesting application of hydrochlorothiazide makes blood pressure easier to reach standard.Conclusion:Regular usage of hydrochlorothiazide tablet can significantly improve the blood pressure standard-reaching rate in SSHT patients.