天津市区成人高血压患者亚临床靶器官损害的流行病学特征及与肾素-血管紧张素-醛固酮系统的关系

目的 了解天津市区成人高血压患者亚临床靶器官损害(TOD)的流行病学特征,探讨其与循环肾素-血管紧张素-醛固酮系统(RAAS)的关系.方法 采用整群随机抽样方法,抽取天津市区成人常住居民进行高血压流行病学调查,推荐无临床合并症的高血压患者进行亚临床TOD[左心室肥厚(LVH),颈动脉内-中膜厚度(IMT)增厚或斑块,微量白蛋白尿(MAU)和肾小球滤过率(eGFR)]的评估.采用多因素Logistic回归分析亚临床TOD与血浆肾素活性、血管紧张素Ⅱ和血清醛固酮水平的关系.结果 1547例无临床合并症的高血压患者参加了亚临床TOD的评估,LVH、颈动脉斑块、颈动脉IMT增厚、MAU和eGFR＜60ml·min-1·(1.73m2)-1的患病率分别为37.7%、38.2%、35.4%、33.7%和4.4%;共有1509例患者完成了所有亚临床TOD的评估,其中20.5%的患者无TOD、34.7%有1个TOD、33.7%有2个TOD,11.1%有3个TOD.Logistic回归分析显示,在校正年龄、性别、吸烟、饮酒、高血压史、体质指数、收缩压、舒张压、高血压持续时间等因素后,血浆血管紧张素Ⅱ水平(OR1.005,95%CI 1.001～1.009,P=0.021)、肾素活性水平(OR 0.870,95%CI0.791～0.958,P=0.005)与LVH独立相关,血清醛固酮水平与颈动脉IMT增厚或斑块(OR 1.025,95%CI 1.000～1.050,P=0.048)及MAU(OR 1.049,95% CI 1.024～1.074,P＜0.001)独立相关.结论 天津市区成人高血压患者亚临床TOD是相当普遍的,RAAS在亚临床TOD中发挥重要作用.

Abstract：

Objective To investigate the epidemiological characteristics of subclinical target organ damage (TOD) among urban adult residents with hypertension in Tianjin and evaluate its relationships with circulating renin-angiotensin-aldosterone system (RAAS). Methods An epidemiological survey was conducted on urban adult residents in Tianjin. The participants with uncomplicated hypertension were followed up to examine for target organ involvement, including left ventricular hypertrophy ( LVH), carotid plaque or intima-media thickening ( IMT),microalbuminuria (MAU) and estimated glomerular filtration rate (eGFR). Multivariate logistic regression was used to evaluate the relations between subclinical TOD and RAAS. Results A total of 1547 subjects with uncomplicated hypertension underwent further examinations for target organ involvement. The prevalence rates of LVH, carotid plaque, carotid IMT, MAU and eGFR ＜60 ml · min-1 · (1.73 m2)-1 were 37.7%, 38.2%, 35.4%, 33.7% and 4.4%, respectively. The prevalence rates were categorized according to the absence or presence of one marker, two or three markers of TOD at 20.5%, 34.7%, 33.7% and 11.1% respectively. According to the logistic regression analysis adjusting for age, gender, current smoking, current drinking, previous antihypertensive treatment, body mass index, mean systolic blood pressure, mean diastolic blood pressure, duration of hypertension and other risk factors, plasma renin activity ( OR 0.870, 95 % CI 0.791 -0.958, P = 0. 005 ) and plasma angiotensin Ⅱ (OR 1.005, 95% CI 1.001 -1.009, P =0.021 ) levels were independently associated with LVH,serum aldosterone level was independently associated with carotid IMT or plaque ( OR 1. 025, 95% CI 1. 000- 1. 050, P = 0. 048 ) and MAU ( OR 1. 049, 95% CI 1. 024 - 1. 074, P ＜ 0. 001 ). Conclusion Subclinical TOD is fairly common among urban adult residents with hypertension in Tianjin. And RAAS plays an important role in the pathogenesis of subclinical TOD.

Epidemiological characteristics of subclinical target organ damage in urban adult residents with hypertension in Tianjin and its relationships with renin-angiotensin-aldosterone system

Objective To investigate the epidemiological characteristics of subclinical target organ damage (TOD) among urban adult residents with hypertension in Tianjin and evaluate its relationships with circulating renin-angiotensin-aldosterone system (RAAS). Methods An epidemiological survey was conducted on urban adult residents in Tianjin. The participants with uncomplicated hypertension were followed up to examine for target organ involvement, including left ventricular hypertrophy ( LVH), carotid plaque or intima-media thickening ( IMT),microalbuminuria (MAU) and estimated glomerular filtration rate (eGFR). Multivariate logistic regression was used to evaluate the relations between subclinical TOD and RAAS. Results A total of 1547 subjects with uncomplicated hypertension underwent further examinations for target organ involvement. The prevalence rates of LVH, carotid plaque, carotid IMT, MAU and eGFR ＜60 ml · min-1 · (1.73 m2)-1 were 37.7%, 38.2%, 35.4%, 33.7% and 4.4%, respectively. The prevalence rates were categorized according to the absence or presence of one marker, two or three markers of TOD at 20.5%, 34.7%, 33.7% and 11.1% respectively. According to the logistic regression analysis adjusting for age, gender, current smoking, current drinking, previous antihypertensive treatment, body mass index, mean systolic blood pressure, mean diastolic blood pressure, duration of hypertension and other risk factors, plasma renin activity ( OR 0.870, 95 % CI 0.791 -0.958, P = 0. 005 ) and plasma angiotensin Ⅱ (OR 1.005, 95% CI 1.001 -1.009, P =0.021 ) levels were independently associated with LVH,serum aldosterone level was independently associated with carotid IMT or plaque ( OR 1. 025, 95% CI 1. 000- 1. 050, P = 0. 048 ) and MAU ( OR 1. 049, 95% CI 1. 024 - 1. 074, P ＜ 0. 001 ). Conclusion Subclinical TOD is fairly common among urban adult residents with hypertension in Tianjin. And RAAS plays an important role in the pathogenesis of subclinical TOD.