难以控制的高血压628例病因分析

目的 了解难以控制的高血压患者病因构成及其在不同性别和年龄中的分布特点.方法 采用回顾性研究方法 ,分析近8年来在新疆维吾尔自治区人民医院高血压专科住院的628例难以控制的高血压患者的病因分类及其在不同性别和年龄段中的分布情况.结果 (1)628例难以控制的高血压患者中原发性高血压占80.1%(503/ 628),继发性高血压占18.9%(119/ 628),病因待定者占1.0%(6/ 628);在继发性高血压中,肾血管性高血压和睡眠呼吸暂停综合征所占比例较高,分别为33.6%和23.5%;在内分泌性高血压中,原发性醛同酮增多症所占比例最高(13.5%).(2)在难以控制的高血压患者中男性多于女性,原发性高血压、继发性高血压、肾实质性高血压、睡眠呼吸暂停综合征、原发性醛固酮增多症男性所占的比例都高于女性;嗜铬细胞瘤女性的比例高于男性;肾血管性高血压男女所占比例相同.(3)难以控制的继发性高血压在青年中所占比例最大(33.1%),老年人中所占比例最小(13.8%).结论 本组难以控制的高血压患者中,原发性高血压占比例最高;在继发性高血压中,肾血管性高血压和睡眠呼吸暂停综合征所占比例较高;内分泌性高血压中,原发性醛固酮增多症所占的比例最高;青年患者所占比例显著大于老年人.     

高血压住院患者病因及危险因素分析

目的分析近年来高血压病因学及危险因素的变化趋势.方法采用回顾性研究方法,分析高血压专科诊断明确的2274例住院患者的病因分类及其危险因素.结果(1)2 274例高血压患者中原发性高血压86%,继发性高血压占14%.在继发性高血压中,内分泌性高血压占51.3%,肾血管性高血压占24.8%;肾性高血压占22.3%.(2)原发性醛固酮增多症在继发性高血压中的患病率最高,占40.2%;在肾血管性高血压中,动脉粥样硬化成为肾血管性高血压的主要病因.(3)对原发性高血压的危险因素分析显示超重与肥胖者占总数的76.2%;糖代谢异常者约占总人数的55.3%;脂代谢异常者比例高达69.5%以上;尿酸代谢障碍者约占31.7%.(4)颈动脉增厚、左室肥厚、慢性肾功能不全和脑卒中的发病率分别为38.1%,26.2%,13.3%和14.4%.(5)原发性高血压患者的靶器官损害与危险因素的Logistic回归分析显示血压分级和年龄是颈动脉增厚的决定因素、血压分级和体重指数(BMI)是左室肥厚的决定因素,年龄、血压分级、BMI和尿酸是肾功能损害的决定因素,年龄和血压分级是脑卒中的决定因素(P＜0.05).结论原发性高血压是高血压的主要病因.在继发性高血压中原发性醛固酮增多症的所占比例增加,动脉粥样硬化已成为肾血管性高血压的主要病因.超重与肥胖、糖脂、尿酸代谢异常仍是原发性高血压的主要危险因素.高血压住院患者中靶器官损害的发生率高,血压水平、年龄和BMI与EH的靶器官损害关系密切.     

新疆维吾尔自治区人民医院住院高血压患者病因构成特点

目的了解高血压专科住院患者病因学及其在不同性别和年龄中的分布情况。方法采用回顾性研究方法,分析4642例新疆维吾尔自治区人民医院高血压专科住院患者的病因分类及其在不同性别和年龄段中的分布情况。结果（1）4642例高血压专科住院患者中原发性高血压占85．24％,继发性高血压占14．76％;在继发性高血压中,睡眠呼吸暂停综合征和焦虑症所占比例较高,分别达到了42．92％和15．04％;在内分泌性高血压中,原发性醛固酮增多症所占比例最高（12．12％）。（2）男性高血压患者多于女性高血压患者,原发性高血压、睡眠呼吸暂停综合征、原发性醛固酮增多症男性所占的比例都高于女性;焦虑症、嗜铬细胞瘤、肾血管性高血压女性的比例高于男性。（3）继发性高血压在青年中所占比例最大（21．9％）,老年人中所占比例最小（9．85％）。结论年轻的患者应除外继发性高血压,积极筛查和鉴别睡眠呼吸暂停综合征和焦虑症。对于内分泌性高血压,原发性醛固酮增多症所占的比例最高,尤其在中青年男性;而嗜铬细胞瘤女性略多于男性。     

高血压住院患者病因及危险因素分析

目的 分析近年来高血压病因学及危险因素的变化趋势。方法 采用回顾性研究方法，分析高血压专科诊断明确的2274例住院患者的病因分类及其危险因素。结果 （1）2274例高血压患者中原发性高血压86％，继发性高血压占14％。在继发性高血压中，内分泌性高血压占51．3％，肾血管性高血压占24．8％；肾性高血压占22．3％。（2）原发性醛固酮增多症在继发性高血压中的患病率最高，占40．2％；在肾血管性高血压中，动脉粥样硬化成为肾血管性高血压的主要病因。（3）对原发性高血压的危险因素分析显示：超重与肥胖者占总数的76．2％；糖代谢异常者约占总人数的55．3％；脂代谢异常者比例高达69．5％以上；尿酸代谢障碍者约占31．7％。（4）颈动脉增厚、左室肥厚、慢性肾功能不全和脑卒中的发病率分别为38．1％，26．2％，13、3％和14．4％。（5）原发性高血压患者的靶器官损害与危险因素的Logistic回归分析显示血压分级和年龄是颈动脉增厚的决定因素、血压分级和体重指数（BMI）是左室肥厚的决定因素，年龄、血压分级、BMI和尿酸是肾功能损害的决定因素，年龄和血压分级是脑卒中的决定因素（P〈0．05）。结论 原发性高血压是高血压的主要病因。在继发性高血压中：原发性醛固酮增多症的所占比例增加，动脉粥样硬化已成为肾血管性高血压的主要病因。超重与肥胖、糖脂、尿酸代谢异常仍是原发性高血压的主要危险因素。高血压住院患者中靶器官损害的发生率高，血压水平、年龄和BMI与EH的靶器官损害关系密切。     

518例初诊高血压住院患者病因分析

目的以探讨高血压患者的病因构成,为提高高血压病因正确诊断提供参考。方法采用回顾性分析方法,分析2006年12月26日～2011年12月31日在我院高血压专科住院的518例初诊高血压患者的病因构成。结果 （1）518例初诊高血压患者中,原发性高血压占73.0%（378/518）,继发性高血压27.0%（140/518）;（2）140例继发性高血压中占比例依次为,原发性醛固酮增多症40.7%（57/140）;睡眠呼吸暂停综合征24.3%（34/140）;甲状腺功能亢进症10.7%（15/140）,慢性肾小球肾炎10.0%（14/140）,肾动脉狭窄7.1%（10/140）,甲状腺功能减退症、大动脉狭窄、皮质醇增多症及嗜铬细胞瘤所占比例较少。结论 518例住院初诊高血压患者中,原发性高血压发生率最高,继发性高血压发生率以原发性醛固酮增多症及睡眠呼吸暂停综合征最高,应注重在初诊高血压病人中进行继发性高血压的排查。     

超声心动图对高血压患者左心室负荷的研究(附250例分析)

本文选择1980～1986年住院的高血压患者250例(男127,女123),年龄16～82岁(平均40.6岁)。病史1个月～30年(平均9.3年)。病因分析;原发性高血压140例(Ⅰ期23例、Ⅱ期107例、Ⅲ期10例);继发性高血压110例(肾血管性高血压58例、肾实质性高血压13例、原发性醛固酮增多症26例、     

影像学在高血压病诊断及鉴别诊断应用

成人高血压原发性与继发性分别占90%及10%.20世纪60年代上海一组4939例病因调查,原发性高血压88.9%,继发性(症状性)11.1%.其中肾性5.3%、肾血管性4.4%、主动脉缩窄0.6%、原发性醛固酮增多症0.4%、柯兴氏综合征0.3%、噬铬细胞瘤0.1%.     

继发性高血压24 h动态血压观察

本研究通过对 31例继发性高血压 (SH)患者进行 2 4h动态血压监测并与年龄、性别相匹配的 30例原发性高血压 (EH)患者进行比较 ,探讨SH患者2 4h动态血压变化规律。1　对象与方法31例SH患者均为 1 997～ 2 0 0 2年在我科住院的患者 ,男 1 8例 ,女 1 3例 ,年龄 ( 4 5 .35± 1 5 .74)岁。其中肾血管性高血压 1 5例 (均经生化、肾动脉造影明确诊断 ) ,原发性醛固酮增多症 1 6例 (均经生化、肾上腺CT、手术病理证实 )。 30例EH患者 ,男 1 7例 ,女 1 3例 ,年龄 ( 5 0 .2 3± 1 1 .48)岁。2 4h动态血压检测 3d内停服降压药 ,使用无创性携带式动…     

醛固酮瘤治愈评分预测高血压的预后

<正>原发性醛固酮增多症(primary aldosteronism,PA)是继发性高血压最常见的病因之一,在高血压患者中其发病率为5%~18%。其最常见的病因包括双侧原发性增生(特发性醛固酮增多症)和单侧醛固酮腺瘤(aldosterone-producing adenoma,APA),分别占60%~65%和30%~35%。独立于高血压的效应,过量的醛固酮会对心血管、肾和中枢神经系统产生不良     

先天性主动脉缩窄致高血压1例

继发性高血压占高血压总数的5%左右,其中又以肾实质性高血压、肾血管性高血压、原发性醛固酮增多症和嗜铬细胞瘤为多见,因各自有其特征性的临床表现和实验室检查方法,临床医生对此不陌生。而先天性主动脉缩窄因临床较少见,故易被忽视[1]。1临床资料患者,女性,19岁,因发现血压升高12年就诊。患者7岁时首次发现血压升高,当时血压为160/90mmHg(1mmHg=0.133kPa),曾到多家医院就诊,诊断为     

Myocardial ultrasonic backscatter in hypertension: relation to aldosterone and endothelin

A disproportionate accumulation of fibrillar collagen is a characteristic feature of hypertensive heart disease, but the extent of myocardial fibrosis may differ in different models of hypertension. In experimental studies, aldosterone and endothelins emerge as important determinants of myocardial fibrosis. Changes in myocardial extracellular matrix and collagen deposition can be estimated noninvasively by analysis of the ultrasonic backscatter signal, which arises from tissue heterogeneity within the myocardium and describes myocardial texture. This study was designed to investigate the relations between myocardial integrated backscatter and circulating aldosterone and immunoreactive endothelin in human hypertension. The study population consisted of 56 subjects: 14 healthy normotensive volunteers and 42 hypertensive patients (14 with primary aldosteronism, 7 with renovascular hypertension, and 21 with essential hypertension). The patients with essential and secondary hypertension were matched for age, gender, body mass index, and blood pressure. Myocardial integrated backscatter at diastole was 19.8+/-2.0 and 20.8+/-2.9 decibels in normotensive control subjects and patients with essential hypertension and significantly higher in patients with primary aldosteronism (27.4+/-3.8 decibels, P<0.01) and renovascular hypertension (26.8+/-4.8 decibels, P<0.01). In the population as a whole, as well as in the hypertensive subpopulation, myocardial integrated backscatter was directly related to plasma aldosterone (r=0.73 and 0.71, P<0.01 for both) and immunoreactive endothelin (r=0.60 and 0.56, P<0.01 for both). The data of this study suggest that in human hypertension, circulating aldosterone and immunoreactive endothelin may induce alterations in left ventricular myocardial texture, possibly related to increased myocardial collagen content.     

Cytosolic free calcium concentration in platelets in patients with renovascular hypertension and primary aldosteronism.

To investigate the role of cytosolic free calcium, [Ca2+]i, in secondary hypertension, the levels in platelets from 14 secondary hypertensives (7 renovascular hypertension, 7 primary aldosteronism) were compared with those from 21 essential hypertensives and 15 normotensives by means of the fluorescent indicator, quin-2. The mean BP was significantly higher in both the secondary hypertensives and essential hypertensives (122 +/- 8 and 124 +/- 12 mmHg) than in the normotensives (89 +/- 10 mmHg). Cytosolic free calcium in platelets was significantly higher in the essential hypertensives, but not in the secondary hypertensives, compared with the normotensives (182 +/- 34, 141 +/- 17, 138 +/- 15 nM respectively). There was no significant difference in platelet [Ca2+]i between renovascular hypertension and aldosteronism (142 +/- 19 versus 139 +/- 16 nM). There was no correlation between platelet [Ca2+]i and plasma renin activity, plasma aldosterone concentration or plasma noradrenaline concentration in the three groups. Thus, the increase in platelet [Ca2+]i seen in essential hypertension was not found in patients with secondary hypertension. Our results suggest that the cytosolic calcium handling of secondary hypertensive patients with renal artery stenosis or primary aldosteronism differs from that of essential hypertensives.     

Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension

Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9-14.2]; P<0.01), neck circumference ≥41 cm for women and ≥43 cm for men (odds ratio: 4.7 [95% CI: 1.3-16.9]; P=0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.3-11]; P=0.02) were predictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common condition associated with resistant hypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.     

Screening for Primary Aldosteronism is Underutilized in Patients with Obstructive Sleep Apnea

BackgroundResistant hypertension is common in patients with primary aldosteronism and in those with obstructive sleep apnea. Primary aldosteronism treatment improves sleep apnea. Despite Endocrine Society guidelines’ inclusion of sleep apnea and hypertension co-diagnosis as a primary aldosteronism screening indication, the state of screening implementation is unknown.MethodsAll hypertensive adult patients with obstructive sleep apnea (n = 4751) at one institution between 2012 and 2020 were compared with a control cohort without sleep apnea (n = 117,815). We compared the association of primary aldosteronism diagnoses, risk factors, and screening between both groups. Patients were considered to have screening if they had a primary aldosteronism diagnosis or serum aldosterone or plasma renin activity evaluation.ResultsObstructive sleep apnea patients were predominantly men and had higher body mass index. On multivariable analysis, hypertensive sleep apnea patients had higher odds of drug-resistant hypertension (odds ratio [OR] 2.70; P < .001) and hypokalemia (OR 1.26; P < .001) independent of body mass index, sex, and number of antihypertensive medications. Overall, sleep apnea patients were more likely to be screened for primary aldosteronism (OR 1.45; P < .001); however, few patients underwent screening whether they had sleep apnea or not (pre-guideline publication 7.8% vs 4.6%; post-guidelines 3.6% vs 4.6%; P < .01). Screening among eligible sleep apnea patients remained low prior to and after guideline publication (4.4% vs 3.4%).Conclusions: Obstructive sleep apnea is associated with primary aldosteronism risk factors without formal diagnosis, suggesting screening underutilization and underdiagnosis. Strategies are needed to increase screening adherence, as patients may benefit from treatment of concomitant primary aldosteronism to reduce sleep apnea severity and its associated cardiopulmonary morbidity.     

Role of aldosterone in left ventricular hypertrophy in hypertension

BACKGROUND: Aldosterone induces cardiac fibrosis in experimental animal models, but only limited information is available on the association between aldosterone and left ventricular (LV) hypertrophy in human beings. The aim of the present study was to determine the role of aldosterone in LV geometry and to investigate other types of target organ damage in hypertensive patients. METHODS: A total of 25 patients with primary aldosteronism caused by Conn's adenoma, 29 patients with renovascular hypertension, and 29 patients with essential hypertension (EHT) were included in the present study. Echocardiographic examinations and 24-h ambulatory blood pressure (BP) monitoring were conducted in all subjects. RESULTS: The mean 24-h systolic and diastolic BP in primary aldosteronism and renovascular hypertension were found to be comparable to those in EHT. However, LV mass index adjusted by age, sex, mean 24-h systolic BP, mean 24-h pulse rate, body mass index, and duration of hypertension was significantly increased in the patients with primary aldosteronism and renovascular hypertension compared with values in patients with EHT (150.2 +/- 7.7, 142.3 +/- 7.2, and 115.2 +/- 7.2 g/m(2), respectively). Hypertensive organ damages, such as proteinuria and hypertensive retinopathy, were more pronounced in the patients with renovascular hypertension; however, LV hypertrophy was especially exaggerated in patients with primary aldosteronism. CONCLUSIONS: These results indicate that aldosterone may induce LV hypertrophy in human beings as well as in experimental animals, and that angiotensin II and aldosterone may differentially participate in causing hypertensive target organ damage.     

规范筛查流程下住院高血压患者的病因构成分析

目的分析在现代规范的高血压筛查流程下阜外医院高血压中心近两年住院高血压患者的病因构成。方法采用回顾性研究方法,分析在现代规范的继发性高血压筛查流程下阜外心血管病医院高血压病区2011年9月至2013年8月住院高血压患者的病因及构成情况。结果（1）共1440例住院高血压患者,其中继发性高血压677例,占47．O％,男性294例（43。4％）,平均年龄39,834-12．03岁。（2）本中心继发性高血压的首位病因为原发性醛固酮增多症198例,29。2％（198／677）,其次为多发性大动脉炎（累及降主动脉和肾动脉）160例。23．6％（160／677）,粥样硬化性肾动脉狭窄126例,18．6％（126／677）、睡眠呼吸暂停综合征58例,8,6％（58／677）,及其他135例,19．9％。结论我中心在现代规范的高血压筛查流程下,住院高血压患者的继发性高血压检出率明显提高,病因构成比发生了明显变化。     

Prevalence of secondary hypertension and unusual aspects of the treatment of hypertension in elderly individuals

Although hypertension is very common in elderly subjects, there is little Published evidence on the effects of age on the Prevalence of ”secondary“ hypertension. Data derived from 2,880 untreated hypertensive subjects are Presented, showing that with increasing age from <18 to >70 years, the Prevalence of orthostatic hypertension falls from 17 to 4% while that of Primary aldosteronism, Cushing's syndrome and Pheochromocytoma changes very little and the Prevalence of hypertension due to hypothyroidism, renovascular stenosis and renal insufficiency increases Progressively, so that almost 10% of hypertensive Patients older than 60 years had renovascular hypertension or renal insufficiency. The SHEP study has shown that treatment of hypertension in the elderly significantly reduced cardiovascular but not total mortality. In secondary hypertension, specific, pathogenesis-related therapy is recommended and often effective. In elderly Patients with Primary hypertension, therapeutic decisions are influenced by the need to minimize side effects (such as orthostatic hypotension), the desirability of avoiding excessive reduction in (especially) diastolic Pressures, and the Possibility that in some situations treatment may actually reduce life expectancy.     

赖诺普利治疗原发性高血压及其合并睡眠呼吸暂停的临床试验

目的本临床试验旨在说明麦道心宁（赖诺普利，Ｌｉｓｉｎｏｐｒｉｌ）的抗高血压效果和其对高血压合并睡眠呼吸暂停综合征的可能影响。方法采用随机、开盲、治疗前后对照法。共有６０例原发性高血压患者分别在北京的三家医院参加本研究，其中２０例患者接受了睡眠呼吸（ＰＳＧ）和动态血压（ＡＢＰ）监测，１２例ＡＢＰ、８例ＰＳＧ加ＡＢＰ治疗前后资料完整，６例合并睡眠呼吸暂停综合征。结果赖诺普利２４小时ＳＢＰ的降压谷／峰比值（Ｔ／Ｐｒａｔｉｏ）为７２．０７％；ＤＢＰ为７２．６１％。治疗对合并睡眠呼吸暂停的病人无明显不良影响。