原发性高血压患者亚临床靶器官受损与肥胖的关系研究

目的分析原发性高血压患者亚临床靶器官受损与肥胖的关系。方法选择我院收治的100例高血压合并肥胖的患者作为观察组,并选择100例单纯性高血压患者作为对照组,调查分析原发性高血压患者亚临床靶器官受损与肥胖的关系。结果观察组尿微量清蛋白、颈动脉粥样硬化发生率高于对照组,差异有统计学意义(P<0.05)。影响尿微量清蛋白的主要因素是收缩压(SBP)、体质指数(BMI)和糖化血红蛋白;影响颈动脉异常的主要因素是年龄、SBP、总胆固醇(TC)和BMI。结论原发性高血压患者亚临床靶器官受损与肥胖的发生率有一定的关系。     

老年性高血压患者的静息心率增加与靶器官损害的相关性研究

该文目的是探讨老年高血压病患者静息心率（resting heart rate，RHR）与靶器官损害的关系。方法：入选老年高血压病患者206例，按收缩压（SBP）水平分为3组：SBP〈160mmHg（1mmHg=0．133kPa），160mmHg≤SBP〈180mmHg，SBP≥180mmHg。在以上每一组中，又按RHR水平分为：RHR1组，〈65次／min；RHR2组，65次／min≤RHR〈69次／min；RHR3组，70次／min≤RHR〈74次／min；RHR4组，75次／min≤RHR〈79次／min；RHR5组，RHR≥80次／min。对入选患者做以下检查：心电图、超声心动图、颈动脉超声、肌酐清除率以及尿微量白蛋白。     

原发性高血压患者脉压与靶器官损害的关系

近年来，有关脉压(PP)与心脏血管疾病关系的流行病调查和临床随访结果表明，PP增大是心脑血管疾病危险度增高的标志之一，且24小时平均PP较偶测脉压估测心血管事件更为可靠。2002年8月至2003年2月，我们研究了原发性高血压患者PP与靶器官损害的关系。现报告如下。     

肥胖相关性高血压患者中心动脉压与靶器官损害相关性分析

【摘要】目的 探讨肥胖相关性高血压患者靶器管损害程度及中心动脉压（CBP）对靶器管损害的影响。方法 纳入徐州市中心医院2014年6月至2019年6月收住入院的高血压患者150例。根据高血压患者体质量指数,将样本分为正常体重高血压组（BMI<24Kg/m2）、超重高血压组(24 Kg/m2≤BMI<28 Kg/m2)、肥胖高血压组（BMI≥28 Kg/m2）。比较三组患者靶器管损害的差异及其与中心动脉压、24小时动态血压的相关性。结果 (1)与正常体重高血压组、超重高血压组比较,肥胖高血压组BMI、腰围、空腹血糖、同型半胱氨酸（HCY）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-c）、颈-股脉搏波传导速度(c-fPWV)、左心室质量（LVM）、左心室质量指数（LVMI）、尿微量白蛋白（mALB）较高（P<0.05）。(2)高血压患者c-fPWV与中心动脉脉压差（CPP）呈正相关（r=0.580,P=0.001）;LVMI与中心动脉收缩压（CSBP）呈正相关（r=0.279,P=0.004）;mALB与CSBP呈正相关（r=0.333,P=0.001）。结论 体重增加可进一步加重高血压患者靶器管损害,中心动脉压较24小时动态血压对高血压患者靶器管损害更为密切。     

心血管疾病危险人群中微量白蛋白尿与颈动脉粥样硬化及外周动脉疾病的关系

目的评价存在心血管疾病危险因素但无明确心脑血管疾病的患者中,微量白蛋白尿(MA)与颈动脉粥样硬化(AS)及外周动脉疾病(PAD)的关系。方法采用横断面研究,277例住院有心血管疾病危险因素但无明确心脑血管疾病的患者,根据其尿白蛋白/肌酐(UACR)水平分为两组:微量白蛋白尿组(MA组,男:17 mg/g≤UACR≤250 mg/g;女:25 mg/g≤UACR≤355 mg/g)及不伴微量白蛋白尿组(NMA组,男:00.05)。结论心血管疾病高危患者中,伴MA者颈总动脉AS和PAD的危险性均增加,MA与颈总动脉AS的关系较与PAD的关系更加明显。     

原发性高血压患者动态脉压与靶器官损害的关系

对183例原发性高血压患者行24 h无创动态血压监测,按动态脉压分为A组(脉压＜60 mmHg)61例、B组(脉压60～80眦Hg)75例、C组(脉压＞80mmHg)47例,分别行血肌酐、心电图、超声心动图、颈动脉超声检查.发现C组患者左心室重量指数、颈动脉斑块指数、左心室舒张末径均高于其他两组,靶器官损害发生率最高.认为脉压增大是左心室肥厚和颈动脉内膜增厚的危险因素.     

高血压病患者的脉压与靶器官亚临床损害的关系

大量的研究已表明中老年高血压病患者中，脉压（PP）是心血管疾病的独立预测因子，是反映脑卒中、心脏疾病以及肾功能损害的重要指标。颈动脉内膜-中膜厚度（CIMT）的增加，左室重量指数（LVMI）增大和尿微量白蛋白排出率（UAE）异常是心、脑、肾等靶器官的亚临床损害的表现。     

老年隐性高血压患者血压变异性与颈动脉粥样硬化及尿微量白蛋白的相关性

目的探讨老年隐性高血压患者血压变异性与颈动脉粥样硬化及尿微量白蛋白(MAU)的相关性。方法选取2013年7月至2014年7月来该院体检者120例,根据体检者血压分为对照组(血压正常者75例)和研究组(隐形高血压者45例),检测入选者颈动脉内膜中层厚度(IMT)、MAU及硬化系数β值。结果研究组自测收缩压(SBP)、自测舒张压(DBP)、DBP变异性及SBP变异性均显著大于对照组(P0.05);研究组IMT、MAU以及硬化系数β值均显著高于对照组(P0.05);研究组自测SBP变异性和自测DBP变异性均与IMT、MAU及硬化系数β值呈正相关(P0.05);隐性高血压患者SBP变异性是IMT、MAU以及硬化系数β值的独立性影响因素。结论老年隐性高血压患者的血压变异性较大,且与颈动脉粥样硬化及MAU存在正相关性。     

老年高血压患者静息心率增加对靶器官损害的临床研究

该文应用动态血压仪监测血压，探讨药物治疗后血压平滑指数变化的临床意义。方法：对55例高血压患者（分别给予缬沙坦或氨氯地平治疗）和31例非高血压者进行24h动态血压监测，并计算如下参数：24h收缩压及舒张压的均值，收缩压及舒张压的平滑指数，血压变异性。其中平滑指数是以全天24h内每小时血压变化值的均值与其标准差的比表示，     

老年高血压临床特点与靶器官损害的相关性

目的:探讨老年高血压的类型、对治疗的反应及其与靶器官损害的相互关系。方法:我院住院的162例老年高血压(EH)患者被分为单纯收缩期高血压(ISH)组和高血压(EH)组;又按治疗反应分为顽固性高血压组和可控制高血压组,观察每组患者的并发症发病率。结果:ISH组与EH组在心律失常、左室肥厚、心肌劳损的发生率上有极显著差异(P<0.01),在脑卒中、肾功能改变的发生率上差异显著(P<0.05)。顽固性高血压组与可控制性高血压组在心律失常、左室肥厚、心肌劳损、脑卒中、肾功能改变的发生率上差异极显著(P<0.01)。结论:重要靶器官合并症的发生率老年单纯收缩期高血压组比高血压组高,顽固性高血压比可控制高血压高。控制高血压可明显改善老年高血压患者的预后。     

Sub-clinical organ damage in hypertension and obesity

Background

The development of sub-clinical organ damage precedes and predicts the occurrence of cardiovascular (CV) events in hypertensive as well as in obese patients.

Aim and methods

We investigated the prevalence and clinical correlates of organ damage (OD), namely carotid atherosclerosis (US scan) and urine albumin to creatinine ratio (three non-consecutive first morning samples) in a group of 164 obese patients and in an age- and gender-matched group of non-obese hypertensive patients.

Results

There was a significantly greater prevalence and severity of OD in obese patients as compared to non-obese hypertensive patients. In particular obese patients more frequently had microalbuminuria (16 vs7%, χ² 5.8, P = 0.0157) and carotid abnormalities (53 vs 10%, χ² 69.5, P < 0.0001) as well as higher urinary albumin excretion rate (−0.05 ± 0.52 vs −0.28 ± 0.43log ACR, P < 0.0001) and carotid intima-media thickness (0.955 ± 0.224 vs 0.681 ± 0.171, <0.0001). Notably, the coexistence of hypertension and obesity did not entail a greater prevalence and severity of OD. Moreover, after adjusting for potentially confounding factors including blood pressure levels, diagnosis of diabetes, and lipid profile, morbidly obese patients showed a 5-fold, and 22-fold higher risk of having microalbuminuria, and carotid atherosclerosis, respectively.

Conclusions

Sub-clinical OD is highly prevalent in obese patients, even in the absence of high blood pressure. Hypertension and obesity seem to exert an independent, possibly non-additive role on the occurrence of organ damage.     

Influence of metabolic syndrome on hypertension-related target organ damage

OBJECTIVES: The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage. DESIGN: Cross-sectional study. SETTING: Outpatient hypertension clinic. SUBJECTS AND METHODS: A total of 353 young and middle-aged hypertensives, free from cardiovascular and renal diseases (and 37% of whom had MS), underwent echocardiographic examination, microalbuminuria determination and non-mydriatic retinography. RESULTS: When compared with subjects without MS, hypertensive patients with MS exhibited more elevated left ventricular (LV) mass (either normalized by body surface area or by height elevated by a power of 2.7), higher myocardial relative wall thickness, albumin excretion rate (AER) and a greater prevalence of LV hypertrophy (57.7% vs. 25.1%; P < 0.00001), of microalbuminuria (36.2% vs. 19.3%; P = 0.002) and of hypertensive retinopathy (87.7% vs. 48.4%; P < 0.00001). These results held even after correction for age, 24-h blood pressures, duration of hypertension, previous antihypertensive therapy, and gender distribution. The independent relationships between LV mass and MS, and between AER and MS, were confirmed in multivariate regression models including MS together with its individual components. CONCLUSIONS: MS may amplify hypertension-related cardiac and renal changes, over and above the potential contribution of each single component of this syndrome. As these markers of target organ damage are well-known predictors of cardiovascular events, our results may partly explain the enhanced cardiovascular risk associated with MS.     

高龄高血压合并糖尿病患者靶器官损害的临床研究

目的研究高龄高血压合并糖尿病患者靶器官损害的特征,为靶器官损害的防治提供依据。方法118例高龄住院患者,平均年龄（86±6）岁,分为高血压病组（EH,35例）、糖尿病组（DM,39例）、高血压合并糖尿病组（EH＋DM,44例）,比较3组患者颈动脉阻力指数、颈总动脉内膜中膜厚度、左心室重量指数、尿微量白蛋白、肌酐清除率等检测结果。结果与EH组、DM组比较,EH＋DM组颈动脉阻力指数均显著升高,颈总动脉内膜-中膜厚度明显增厚。EH＋DM组患者斑块指数明显高于单纯EH组、DM组。DM、EH及EH＋DM组患者左心室重量指数（LVMI）、收缩期升主动脉内径（AOD）有显著差异,其中EH＋DM组患者LVMI、AOD高于其余2组;EH＋DM组尿微量蛋白高于EH组和DM组,内生肌酐清除率低于EH组和DM组。结论高龄高血压合并糖尿病患者,靶器官损害危险性明显增加。     

The cumulative blood pressure load and target organ damage in patients with essential hypertension

The area under the blood pressure curve is associated with target organ damage, but accurately estimating its value is challenging. This study aimed to improve the utility of the area under the blood pressure curve to predict hypertensive target organ damage. This retrospective cohort study comprised of 634 consecutive patients with essential hypertension for >1 year. Target organ damage was defined as the presence of left ventricular hypertrophy and/or carotid artery plaques. We evaluated the associations between the cumulative blood pressure load, which was derived from ambulatory blood pressure monitoring data, and target organ damage. The predictive value of the cumulative blood pressure load for target organ damage was assessed using receiver operating characteristic curves. Left ventricular hypertrophy and carotid artery plaques were present in 392 (61.8%) and 316 (49.8%) patients, respectively. Patients with left ventricular hypertrophy and/or carotid artery plaques had higher 24‐hour blood pressure, nocturnal cumulative systolic blood pressure, and nocturnal cumulative pulse pressure load. The nocturnal cumulative systolic blood pressure load was an independent predictor of left ventricular hypertrophy (odds ratio = 1.002, 95% confidence interval: 1.001‐1.004; P = .000) and carotid artery plaques (odds ratio = 1.003, 95% confidence interval: 1.002‐1.007; P = .007). The nocturnal cumulative systolic blood pressure and cumulative pulse pressure load, relative to mean blood pressure, were superior in predicting hypertensive target organ damage. Hence, the cumulative blood pressure load is a better indicator of blood pressure consequences, and the nocturnal cumulative systolic blood pressure and cumulative pulse pressure loads could predict target organ damage.     

隐蔽性高血压患者靶器官损害临床分析简

目的 探讨隐蔽性高血压患者靶器官损害情况.方法 入选2008年8月至2012年6月在宝钢集团广东韶关钢铁有限公司医院进行体检的人群474例为研究对象.根据患者血压水平及动态血压结果将其分为高血压组（n=100）、理想血压组（n=234）和隐性高血压组（n=140）.所有患者均行心脏、颈动脉超声及实验室生化检查.结果 隐蔽性高血压组与高血压组患者的诊所血压比较,差异无统计学意义（P＞0.05）;与理想血压组相比,隐蔽性高血压组、高血压组患者动态血压参数均显著升高,差异均具有统计学意义（P＜0.01或P＜0.05）;隐蔽性高血压组左心室质量指数、尿微量白蛋白、血肌酐、颈动脉内膜中层厚度显著高于理想血压组,而低于高血压组,差异有统计学意义（P＜0.01或P＜0.05）.结论 隐蔽性高血压患者存在明显靶器官损害,对这类患者及早进行干预具有非常重要的临床意义.     

Subclinical target organ damage in subjects with different components of metabolic syndrome

Background: To assess the association of metabolic syndrome (MS) and its components with target organ damage in a follow-up study of relatively healthy bank employers.

Methods: Out of 1600 random samples of office workers in Saint Petersburg (Russia), a group of 383 participants with at least one component of MS and without cardiovascular complications was selected (mean age 46.6 ± 9.0 years, 214 females (64.6%)). Follow-up visit was performed in 331 subjects. Target organ damage (TOD) was assessed by echocardiography, carotid ultrasound, applanational tonometry, brachial–ankle index, and urine albumin excretion measurements. Anthropometry, vital signs, and biochemistry were performed according to standard protocols.

Results: Presence of MS was not associated with higher probability of TOD. Multiple linear regression revealed significant association of all markers of TOD with older age. Hypertension was a significant predictor of left ventricular hypertrophy (LVH), increased arterial stiffness, and early signs of carotid atherosclerosis in logistic regression adjusted for age and gender. During follow-up, proportion of patients with LVH significantly decreased (from 46.7% to 32.9%, р = 0.003) and prevalence of patients with IMT > 0.09 сm increased (from 24.5% to 44.1%, p < 0.001) accompanying by significant declining of office blood pressure (BP) and total cholesterol.

Conclusions: MS per se is not related to increased probability to TOD. Hypertension, female gender, and older age are main determinants of subclinical changes. After 2-years follow-up, significant LVH and renal damage regression was observed probably owing to BP reduction. Alternatively, early signs of carotid atherosclerosis increase with aging despite decreasing of the prevalence of hypercholesterolemia.     

白大衣高血压与隐性高血压患者心血管危险因素及靶器官损害比较

目的 比较白大衣高血压与隐性高血压患者心血管危险因素及靶器官损害.方法 入选2009年12月至2012年12月在我院进行查体人员327例,其中理想血压者157例,隐性高血压患者92例,白大衣高血压78例,所有患者均行心脏、颈动脉超声及实验室检查.结果 白大衣高血压组患者空腹血糖及体质量指数高于理想血压组而低于隐性高血压组患者,P＜0.01或P＜0.05;白大衣高血压组患者诊所测量血压显著高于隐性高血压组及理想血压组,差异具有统计学意义（P＜0.01或P＜0.05）;白大衣高血压组左室质量指数、尿微量白蛋白、血肌酐、IMT显著高于理想血压组而低于隐性高血压组,P＜0.01或P＜0.05.结论 与理想血压组患者相比,隐性高血压及白大衣高血压组患者均存在显著的靶器官损害,且隐性高血压组较白大衣高血压组严重.     

Sex‐related relationships between uric acid and target organ damage in hypertension

Heterogeneous results have been obtained in the relationship between serum uric acid (SUA) and target organ damage (TOD) in patients with hypertension. Clinic blood pressure, SUA, and cardiac, arterial (carotid and aortic), and renal TOD were assessed in 762 consecutive patients with hypertension. Hyperuricemia was defined as an SUA >7.0 in men and >6.0 mg/dL in women. Men with hyperuricemia compared with those with normal SUA showed lower estimated glomerular filtration rates and E/A ratios and a higher prevalence of carotid plaques. Women with hyperuricemia showed lower estimated glomerular filtration rates and E/A ratios and a higher intima‐media thickness. Except for pulse wave velocity, all TODs significantly correlated with SUA. However, at multivariate analysis, only estimated glomerular filtration rate was significantly determined by SUA. Our data provide evidence on the role of SUA in the development of TOD only in the case of renal alteration. It is likely that SUA may indirectly act on the other TODs through the increase in blood pressure and the decrease in glomerular filtration rate.     

老年高血压合并代谢异常特征及其对靶器官的影响

目的分析老年原发性高血压患者合并不同代谢异常的临床特征及其对靶器官的影响。方法选择老年高血压患者460例,根据合并代谢异常情况分为6组:A组(单纯高血压,21例),高血压合并腹型肥胖、血脂异常、糖尿病、高尿酸血症及代谢综合征分别为B组(32例)、C组(73例)、D组(54例)、E组(27例)和F组(253例),行相关生化指标检测和超声等检查,综合评估其靶器官损害和并发症情况。结果单纯高血压患者仅占4.6%,95.4%的患者合并1项以上代谢异常。与A组比较,F组体重指数、腰围、空腹血糖、餐后2 h血糖、糖化血红蛋白、TG、尿酸及血肌酐明显升高(P<0.05),HDI-C明显下降(P<0.05);各组高血压病程和血压控制水平相当,但F组较其他组需要多种的抗高血压药物(P<0.05);D组与F组颈动脉内膜中层厚度、尿微量白蛋白/肌酐以及合并冠心病和脑血管病差异有统计学意义(P<0.05)。结论老年高血压患者以多重代谢性危险因素聚集为特征,该特征使靶器官损害和心脑血管病的发生明显增加,且需要多种抗高血压药物联用以控制血压。