高血压住院患者病因构成及靶器官损害情况分析

Analysis of etiology and target organ damage in hospitalized patients with hypertension

目的分析北京阜外医院2016-2017年高血压住院患者的病因情况。方法回顾性分析2016年1月至2017年12月在北京阜外医院高血压病房首次住院的高血压患者的病因构成及靶器官损害情况。结果高血压患者4782例,其中原发性高血压占69.2%,继发性高血压占30.8%。继发性高血压中,睡眠呼吸暂停综合征占62.1%,肾血管性高血压占20.9%,原发性醛固酮增多症(原醛)占16.8%。肾血管性高血压中,动脉粥样硬化占75.3%,为肾动脉狭窄的主要病因。内分泌性高血压中,原醛占66.6%,甲状腺疾病占24.2%,多囊卵巢综合征占5.9%。与原发性高血压相比,继发性高血压患者年龄小[49(38～60)比52(39～62)岁,P<0.05],入院血压高[收缩压150(135～162)比140(130～155)mm Hg,舒张压90(80～100)比86(78～98)mm Hg,均P<0.05],合并主动脉夹层/动脉瘤及外周动脉狭窄/闭塞比例高(均P<0.05),尿微量白蛋白/肌酐水平高[18.0(8.7～40.8)比11.2(4.3～23.1)mg/g,P<0.05]。结论原发性高血压仍是高血压的主要病因。在继发性高血压中,睡眠呼吸暂停综合征、肾血管性高血压、原醛是三大主要病因。继发性高血压较原发性高血压发病年龄小,血压高,靶器官损害重。

Objective To analyse the causes of hypertension in the hospitalized patients in Fuwai Hospital in the past two years.Methods Retrospective analysis of the etiology and target organ damage of patients who were hospitalized for the first time due to hypertension in hypertension department of Fuwai Hospital from January 2016 to December 2017.Results Among 4782 in-patients with hypertension,69.2%were primary hypertension(PH)and 30.8%were secondary hypertension(SH).Among SH,sleep apnea syndrome(SAS)accounted for 62.1%,renal vascular hypertension(RVH)accounted for 20.9%,and primary aldosteronism(PA)accounted for 16.8%.In RVH,atherosclerosis accounted for 75.3%,which was the main cause of renal artery stenosis.Among endocrine hypertension,PA accounted for 66.6%,thyroid disease accounted for 24.2%,and polycystic ovary syndrome(PCOS)accounted for 5.9%.The median age of patients with SH was younger than that of PH(49(38-60)vs 52(39-62)years,P<0.05)The admission blood pressure[systolic pressure 150(135-162)vs 140(130-155)mm Hg,diastolic pressure 90(80-100)vs 86(78-98)mm Hg],incidence rate of aortic dissection/aneurysm and peripheral artery stenosis/occlusion and the ratio of urinary albumin to creatinine[18.0(8.7-40.8)vs 11.2(4.3-23.1)mg/g]in SH patients were significantly greater than those in PH patients(all P<0.05).Conclusions PH is still the main cause of hypertension.SAS,RVH and PA are the three major causes of SH.Compared with PH patients,SA patients are younger,but they have higher blood pressure and heavier target organ damage.