高血压住院患者病因构成及靶器官损害情况分析
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摘要
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.
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.
引文
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[21] 肾脏病相关专家小组.上海慢性肾脏病早发现及规范化诊治与示范项目专家组.慢性肾脏病筛查诊断及防治指南[J].中国实用内科杂志,2017,31(1):27-34.
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[25] 王志华,初少莉,陈绍行,等.高血压住院患者病因及危险因素分析[J].高血压杂志,2005,13(8):504-509.
[26] Marin JM,Agusti A,Villar I,et al.Association between treated and untreated obstructive sleep apnea and risk of hypertension[J].JAMA,2012,307(20):2169-2176.
[27] Pedrosa RP,Drager LF,Gonzaga CC,et al.Obstructive sleep apnea:the most common secondary cause of hypertension associated with resistant hypertension[J].Hypertension,2011,58(5):811-817.
[28] Muxfeldt ES,Margallo VS,Guimaraes GM,et al.Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension[J].Am J Hypertens,2014,27(8):1069-1078.
[29] Chobanian AV,Bakris GL,Black HR,et al.Seventh report of the joint national committee on prevention,detection,evaluation and treatment of high blood pressure[J].Hypertension,2003,42(6):1206-1252.
[30] Whelton PK,Carey RM,Aronow WS,et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention,detection,evaluation and management of high blood pressure in adults:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines[J].Hypertension,2018,71(6):e13-e115.
[31] McEvoy RD,Antic NA,Heeley E,et al.CPAP for prevention of cardiovascular events in obstructive sleep apnea[J].N Engl J Med,2016,375(10):919-931.
[32] Textor SC.Managing renal arterial disease and hypertension[J].Curr Opin Cardiol,2003,18(4):260-267.
[33] Olin JW,Froehlich J,Gu X,et al.The United States registry for fibromuscular dysplasia:results in the first 447 patients[J].Circulation,2012,125(25):3182-3190.
[34] Hiramatsu K,Yamada T,Yukimura Y,et al.A screening test to identify aldosterone producing adenoma by measuring plasma rennin activity.Results in hypertensive patients[J].Arch Intern Med,1981,141(12):1589-1593.
[35] Gordon RD,Stowasser M,Tunny TJ,et al.High incidence of primary aldosteronism in 199 patients referred with hypertension[J].Clin Exp Pharmacol Physiol,1994,21(4):315-318.
[36] Pedrosa RP,Drager LF,Gonzaga CC,et al.Obstructive sleep apnea:the most common secondary cause of hypertension associated with resistant hypertension[J].Hypertension,2011,58(5):811-817.
[37] Pratt-Ubunama MN,Nishizaka MK,Boedefeld RL,et al.Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension[J].Chest,2007,131(2):453-459.
[38] Omura M,Saito J,Yamaguchi K,et al.Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan[J].Hypertens Res,2004,27(3):193-202.
[39] Shigematsu Y,Hamada M,Okayama H,et al.Left ventricular hypertrophy precedes other target organ damage in primary aldosteronism[J].Hypertension,1997,29(3):723-727.
[40] Yao X,Li N,Zhang Y,et al.Plasma aldosterone concentration is positively associated with pulse pressure in patients with primary hypertension[J].Medicine (Baltimore),2015,94(10):e614-617.
[41] 马轩,姚晓光,李南方,等.原发性醛固酮增多症患者中代谢综合征的患病情况[J].中华内分泌代谢杂志,2011,27(9):724-728.
[42] National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:valuation,classification and stratmcation[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1-266.
[43] 李南方,程维平,严治涛,等.睡眠呼吸暂停相关性高血压靶器官损害的调查与分析[J].中华高血压杂志,2011,19(7):642-646.
[44] 李南方,李红建,王新玲,等.原发性醛固酮增多症患者左室结构损害的研究[J].中华内分泌代谢杂志,2012,28(2):117-120.
[45] 李南方,马轩,李红健,等.原发性醛固酮增多症患者蛋白尿情况分析[J].中华高血压杂志,2013,21(3):249-252.
[2] Anderson GH Jr,Blakeman N,Streeten DH.The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients[J].J Hypertens,1994,12(5):609-615.
[3] Omura M,Saito J,Yamaguchi K,et al.Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan[J].Hypertens Res,2004,27(3):193-202.
[4] 中国高血压防治指南修订委员会,中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[5] 中国医师协会睡眠医学专业委员会.成人阻塞性睡眠呼吸暂停多学科诊疗指南[J].中华医学杂志,2018,98(24):1092-1014.
[6] 中国医疗保健国际交流促进会血管疾病高血压分会专家共识起草组.肾动脉狭窄的诊断和处理中国专家共识[J].中国循环杂志,2017,32(9):835-844.
[7] 中华医学会风湿病学分会.大动脉炎诊断及治疗指南[J].中华风湿病学杂志,2011,15(2):119-120.
[8] Persu A,Giavarini A,Touzé E,et al.European consensus on the diagnosis and management of fibromuscular dysplasia[J].J Hypertens,2014,32(7):1367-1378.
[9] 中华医学会内分泌学分会肾上腺学组.原发性醛固酮增多症诊断治疗的专家共识[J].中华内分泌代谢杂志,2016,32(3):188-195.
[10] Song Y,Yang S,He W,et al.Confirmatory tests for the diagnosis of primary aldosteronism:prospective diagnostic accuracy study[J].Hypertension,2018,71(1):118-124.
[11] 中华医学会内分泌学分会.成人甲状腺功能减退症诊治指南[J].中华内分泌代谢杂志,2017,33(2):167-180.
[12] Ross DS,Burch HB,Cooper DS,et al.2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis[J].Thyroid,2016,26(10):1343-1421.
[13] 中华医学会妇产科学分会内分泌学组及指南专家组.多囊卵巢综合征中国诊疗指南[J].中华妇产科杂志,2018,53(1):2-6.
[14] 中华医学会内分泌学分会.库欣综合征专家共识(2011年)[J].中华内分泌代谢杂志,2012,28(2):96-102.
[15] 中华医学会内分泌学分会肾上腺学组.嗜铬细胞瘤和副神经节瘤诊断治疗的专家共识[J].中华内分泌代谢杂志,2016,32(3):181-187.
[16] 中国医师协会肾内科医师分会中国中西医结合学会肾脏疾病专业委员会.中国肾性高血压管理指南2016(简版)[J].中华医学杂志,2017,97(20):1547-1555.
[17] 中华医学会血液学分会白血病淋巴瘤学组.真性红细胞增多症诊断与治疗中国专家共识[J].中华血液学杂志,2016,37(4):265-268.
[18] 中华医学会心血管病学分会.慢性稳定性心绞痛诊断与治疗指南[J].中华心血管病杂志,2007,35(3):195-206.
[19] Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction[J].Eur Heart J,2019,40(3):237-269.
[20] 中华医学会心血管病学分会.中华心血管病杂志编辑委员会.中国心力衰竭治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[21] 肾脏病相关专家小组.上海慢性肾脏病早发现及规范化诊治与示范项目专家组.慢性肾脏病筛查诊断及防治指南[J].中国实用内科杂志,2017,31(1):27-34.
[22] 中国医师协会心血管外科医师分会.大血管外科专业委员会.主动脉夹层诊断与治疗规范中国专家共识[J].中华胸心血管外科杂志,2017,33(11):641-654.
[23] 中华医学会外科学分会.腹主动脉瘤诊断与治疗指南[J].中国实用外科学杂志,2008,28(11):916-918.
[24] Aboyans V,Ricco JB,Bartelink MEL,et al.2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases,in collaboration with the European Society for Vascular Surgery (ESVS)[J].Rev Esp Cardiol (Engl Ed),2018,71(2):111.
[25] 王志华,初少莉,陈绍行,等.高血压住院患者病因及危险因素分析[J].高血压杂志,2005,13(8):504-509.
[26] Marin JM,Agusti A,Villar I,et al.Association between treated and untreated obstructive sleep apnea and risk of hypertension[J].JAMA,2012,307(20):2169-2176.
[27] Pedrosa RP,Drager LF,Gonzaga CC,et al.Obstructive sleep apnea:the most common secondary cause of hypertension associated with resistant hypertension[J].Hypertension,2011,58(5):811-817.
[28] Muxfeldt ES,Margallo VS,Guimaraes GM,et al.Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension[J].Am J Hypertens,2014,27(8):1069-1078.
[29] Chobanian AV,Bakris GL,Black HR,et al.Seventh report of the joint national committee on prevention,detection,evaluation and treatment of high blood pressure[J].Hypertension,2003,42(6):1206-1252.
[30] Whelton PK,Carey RM,Aronow WS,et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention,detection,evaluation and management of high blood pressure in adults:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines[J].Hypertension,2018,71(6):e13-e115.
[31] McEvoy RD,Antic NA,Heeley E,et al.CPAP for prevention of cardiovascular events in obstructive sleep apnea[J].N Engl J Med,2016,375(10):919-931.
[32] Textor SC.Managing renal arterial disease and hypertension[J].Curr Opin Cardiol,2003,18(4):260-267.
[33] Olin JW,Froehlich J,Gu X,et al.The United States registry for fibromuscular dysplasia:results in the first 447 patients[J].Circulation,2012,125(25):3182-3190.
[34] Hiramatsu K,Yamada T,Yukimura Y,et al.A screening test to identify aldosterone producing adenoma by measuring plasma rennin activity.Results in hypertensive patients[J].Arch Intern Med,1981,141(12):1589-1593.
[35] Gordon RD,Stowasser M,Tunny TJ,et al.High incidence of primary aldosteronism in 199 patients referred with hypertension[J].Clin Exp Pharmacol Physiol,1994,21(4):315-318.
[36] Pedrosa RP,Drager LF,Gonzaga CC,et al.Obstructive sleep apnea:the most common secondary cause of hypertension associated with resistant hypertension[J].Hypertension,2011,58(5):811-817.
[37] Pratt-Ubunama MN,Nishizaka MK,Boedefeld RL,et al.Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension[J].Chest,2007,131(2):453-459.
[38] Omura M,Saito J,Yamaguchi K,et al.Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan[J].Hypertens Res,2004,27(3):193-202.
[39] Shigematsu Y,Hamada M,Okayama H,et al.Left ventricular hypertrophy precedes other target organ damage in primary aldosteronism[J].Hypertension,1997,29(3):723-727.
[40] Yao X,Li N,Zhang Y,et al.Plasma aldosterone concentration is positively associated with pulse pressure in patients with primary hypertension[J].Medicine (Baltimore),2015,94(10):e614-617.
[41] 马轩,姚晓光,李南方,等.原发性醛固酮增多症患者中代谢综合征的患病情况[J].中华内分泌代谢杂志,2011,27(9):724-728.
[42] National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:valuation,classification and stratmcation[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1-266.
[43] 李南方,程维平,严治涛,等.睡眠呼吸暂停相关性高血压靶器官损害的调查与分析[J].中华高血压杂志,2011,19(7):642-646.
[44] 李南方,李红建,王新玲,等.原发性醛固酮增多症患者左室结构损害的研究[J].中华内分泌代谢杂志,2012,28(2):117-120.
[45] 李南方,马轩,李红健,等.原发性醛固酮增多症患者蛋白尿情况分析[J].中华高血压杂志,2013,21(3):249-252.
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