高血压的表现类型及临床特征分析

Analysis of the manifestation type and clinical characteristics of hypertension in Chinese

目的 研究上海社区人群的高血压患病率 ,各高血压亚组的临床特征及高血压发生的影响因素。方法 对 5 6 2 8例 2 0岁以上的社区人群进行血压、体重指数 (BMI)、血糖、血脂、胰岛素等测定 ,调查人群中共有高血压 2 173例 ,其中既往有明确高血压史 14 5 6例 ,新发高血压 717例 ,后者根据收缩压和舒张压值被分为单纯收缩期高血压组 (ISH)、单纯舒张期高血压组 (IDH)及收缩期高血压合并舒张期高血压组 (SH +DH) ;然后根据血糖值进一步将新发的高血压人群分成正常血糖组 (NGT)、糖调节受损组 (IGR)及糖尿病组 (DM )。结果 ①高血压的患病率为 38.6 1%。新发高血压者占高血压总人群的 33.0 0 %。新发高血压人群中ISH占 2 6 .2 2 % ,IDH占 4 1.70 % ,SH +DH占 32 .0 8%。②高血压各亚组的BMI、腰围 (W )、腰臀比 (WHR)、三酰甘油 (TG)、餐后2h血糖 (2hPG)均较正常血压组 (NBP)明显升高。③新发高血压者中ISH组年龄大 ,2hPG较高 ,但胰岛素抵抗较轻 ;IDH组年龄轻 ,较肥胖 ,胰岛素抵抗较重 ;而SH +DH组兼有年龄大、肥胖 (腹型肥胖 )及胰岛素抵抗更为严重等特点。④在糖代谢异常伴高血压者中 ,以ISH及SH +DH更为多见。结论 ①总体脂含量、体脂分布、血糖、血胰岛素、血脂是高血压发生的影响因素。

Objective To investigate the prevalence and clinical characteristics of hypertension, as well as the affecting factors of hypertension in Shanghai community. Methods Body weight index(BWI), blood pressure, plasma glucose, lipid profile and serum insulin level were assessed in 5 628 subjects aged over 20 years. There were 1456 subjects with recognized history of hypertension. According to the systolic and diastolic blood pressure, the remaining 4 172 subjects(men 1780, women 2392) were divided into four subgroups as follows: normal blood pressure(NBP), isolated systolic hypertension(ISH), isolated diastolic hypertension(IDH) and systolic combined diastolic hypertension(SH +DH). The subjects with newly diagnosed hypertension were divided into normal glucose tolerance(NGT), impaired glucose regulation(IGR) and diabetes(DM). Results 1.Of the 2173 subjects with hypertension, which accounted 38.61% of this population surveyed, 717 were newly diagnosed. Among this newly diagnosed hypertension population, ISH accounted 26.22%, IDH 41.70% and SH+DH 32.08%. 2. In comparison with NBP subgroup, BMI, waist circumference, waist hip ratio, triglyceride and 2 hour glucose level were significantly increased in all three types of hypertension subgroups. The subjects with ISH were characterized by aging and elevated 2 hour glucose, while SH+DH by increment of waist circumference. The average age of IDH was the lowest. 3. With the aggravation of glucose intolerance, the proportion of ISH in newly diagnose hypertension was increased( P =0.002), while that of IDH was decreased( P <0.001). Conclusion 1. Obesity, hyperglycemia, fasting insulin level and lipid profile may be related with hypertension. 2. The incidence of isolated systolic hypertension was higher in elderly population. Isolated diastolic hypertension is the major type of hypertension in middle aged population.