社区难治性高血压相关危险因素及特点分析

Risk analyses of refractory hypertension in local community

目的探讨社区难治性高血压患者的临床特点和靶器官损害情况,分析相关危险因素。方法回顾性分析2014年8月至2015年8月上海市嘉定区真新社区卫生服务中心随访的高血压患者187例,其中难治性高血压病例94例(观察组),非难治性高血压病例93例(对照组),比较两组临床特点和靶器官损害情况,采用多元Logistic回归模型分析难治性高血压的危险因素。结果两组患者年龄、性别等一般资料差异无统计学意义(P>0.05)。与对照组比较,观察组患者高血压和糖尿病病程均较长,体质量指数(BMI)较高,收缩压及脉压差升高,血肌酐、血尿酸、空腹血糖、糖化血红蛋白、总胆固醇及低密度脂蛋白-胆固醇水平均较高,高密度脂蛋白-胆固醇水平较低,差异均具有统计学意义(P<0.05或0.01),两组患者的舒张压及甘油三酯水平差异无统计学意义(P>0.05)。两组靶器官损害的发生率差异具有统计学意义(P<0.01)。观察组。肾小球滤过率估计值(eGFR)<90 ml/(min.1.73 m^2)、尿微量蛋白阳性以及出现左心室肥厚的病例数均高于对照组,差异均具有统计学意义(P<0.01),观察组出现尿蛋白阳性的病例数也高于对照组,但差异无统计学意义(P>0.05)。BMI及收缩压升高,空腹血糖水平及总胆固醇水平上升,eGFR降低是难治性高血压的独立危险因素。结论难治性高血压的独立危险因素包括BMI升高及糖脂代谢紊乱等,难治性高血压可增加心脑血管疾病和。肾脏疾病的发生风险,具体表现为左心室肥厚,eGFR降低,尿微量蛋白升高等亚临床靶器官的损害。社区高血压病的随访过程中,应引导患者建立良好的生活方式,有效控制体重、血糖、血压和血脂,注意定期复查尿微量蛋白、肾功能、心电图等指标。

Objective To explore the clinical characteristics and target organ damage of refractory hypertension patients in local community,and to analyze related risk factors.Methods A total of 187 hypertension patients who were folio wed-up in Shanghai Jiading District Zhenxin Community Health Service Center from August 2014 and August 2015 were retrospectively recruited in this study.Among them,94 cases were refractory hypertension(observation group),and93 cases were non-refractory hypertension(control group).The clinical characteristics and target organ damage of both groups were compared,and multivariate logistic regression models were applied to analyze the risk factors of refractory hypertension.Results Baseline data of the both group had no significant difference(P>0.05).Compared with the control group,the patients in observation group had longer courses of hypertension and diabetes.They had higher body mass index(BMI),higher systolic blood pressure and pulse pressure,higher serum creatinine,serum uric acid,fasting blood glucose,Hb1 Ac,serum cholesterol and low-density lipoprotein cholesterol.The patients in observation group also had lower level of high-density lipoprotein.All these differences had significant difference(P<0.05 or 0.01).The diastolic pressure and blood triglyceride in both two groups had no significant difference(P>0.05).The incidence rate of target organ damage in two groups had significant difference(P<0.01).The number of cases with estimated glomerular filtration rate(eGFR)<90ml/(min·1.73 m^2),urine microprotein positive or left ventricular hypertrophy in the observation group were larger than those in control group,and the differences were significant(P<0.01).The patients in observation group had more cases with urine protein positive than that in control group,but the difference was not significant(P>0.05).The increased BMI,systolic pressure,fasting blood glucose,serum cholesterol,and the decreased eGFR were considered as the independent risk factors of refractory hypertension.Conclusions The independent risk factors of refractory hypertension includes the increased BMI and the glucose and lipid metabolism disorder.Refractory hypertension could increase the risk of cardiovascular and kidney disease,which could be expressed specifically as subclinical target organ damage,such as left ventricular hypertrophy,decreased eGFR,and higher urine microprotein.During the follow-ups of hypertension in the community,patients should be inducted to build a healthy lifestyle,and should control weight,blood glucose,blood pressure and blood lipid effectively during the treatment.Urine microprotein,kidney function and EKG should also be follow-up at regular intervals.