北京市2671例住院老年高血压患者心脏损害及诊治情况的调查

目的了解北京市老年住院高血压患者的诊治情况以及心脏结构和功能改变的特点,为临床老年高血压的合理诊治提供依据。方法采用流行病学回顾性调查的方法,对60岁以上住院高血压患者的一般情况、病史、超声心动图结果和治疗情况等进行回顾性总结分析。结果共调查病例2671份,其中60～79岁的老年组2238例,≥80岁的老老年组男性383例。所有患者中仅660例（24.7%）未合并危险因素,1758例（65.8%）合并不同的心脏损害,545例（20.4%）合并不同部位的外周动脉硬化,631例（23.6%）合并脑血管病。老年组血压（146.40±24.28）/（81.87±13.31）mmHg,老老年组血压（143.91±21.83）/（76.85±11.93）mmHg。两组患者血压达标率（〈140/90mmHg）分别是33.3%和39.3%,尤以收缩压达标率差。老年高血压患者超声心动图显示存在多种心脏损害,其中E/A比值异常率高达77.3%。临床有心力衰竭表现的患者合并更多的心脏结构异常,包括左房扩大、左室扩大和左室肥厚,超声心动图更多的表现为舒张功能不全。结论（1）北京市住院老年高血压患者合并多种危险因素和靶器官损害;（2）北京市三级医院住院老年高血压患者血压控制率仍较低,尤以收缩压达标率低;（3）临床表现心功能不全的高血压患者超声更多显示心脏舒张功能异常。

The diagnostic and therapeutic conditions of hospitalized aged patients with essential hypertension in Beijing:analysis of 2671 cases

Objective To investigate the diagnostic and therapeutic conditions and characteristics of the cardiac structural and functional abnormalities in hospitalized patients with essential hypertension in Beijing in order to find the reasonable interventional measures. Methods Retrospective epidemiologic method was used. Medical records of hypertensive patients older than 60 years were analyzed, including their general status, medical history, echocardiography results and therapeutic conditions. Results Case files of 2671 patients were analyzed. They were divided into 2 groups, 2238 patients aged 60-79 years were old group, the other 383 patients older than 80 years were very old group. More than 75 % patients were complicated with various kinds of risk factors, 65.8% of them had heart damages, 20.4% had peripheral arteriosclerosis and 23.6% had cerebrovascular diseases. Blood pressure were （146.40± 24. 28）/（81.87±13. 31）mmHg in old group and （143.91±21.83）/（76.85±11.93）mmHg in very old group. Only about one third of the patients （33.3% in old group and 39.3% in very old group） had reached the target blood pressure level （〈140/90mmHg）. Many abnormalities were found in their echocardiograms and the E/A abnormality was found in 77.3% of them, which was the most common change of hypertensive heart injury. Patients complicated with clinical heart failure had more cardiac structural abnormalities, including left atria enlargement, left ventricular enlargement and left ventricular hypertrophy, and their echocardiograms showed more abnormal diastolic dysfunction. Conclusion （1） Hospitalized hypertensive patients in Beijing were complicated with many risk factors and target organ damages. （2） The BP control rate of hospitalized hypertensive patients in Beijing was low, especially SBP. （3） Patients complicated with clinical heart failure had more abnormal diastolic dysfunction in echocardiograms.