青年高血壓病發(fā)病特點及預(yù)后分析研究
發(fā)布時間：2019-03-26 11:43
【摘要】：目的:回顧性分析山西醫(yī)科大學(xué)第一醫(yī)院心內(nèi)科青年高血壓病患者住院診治情況,并隨訪其院外治療依從情況,研究青年高血壓病的發(fā)病特點及治療與預(yù)后的關(guān)系,初步闡明綜合危險控制(包含藥物治療)對靶器官保護(hù)的重要性,以期為臨床工作提供一定的幫助。方法:選取在山大一院心內(nèi)科2005年1月至2015年12月約11年間住院,診斷為青年高血壓病的患者,共計病例314例。根據(jù)患者首診時的血壓水平分為1級青年高血壓組、2級青年高血壓組、3級青年高血壓組三個組別,通過對各組患者住院期間資料及相關(guān)隨訪資料的統(tǒng)計分析,研究青年高血壓病的發(fā)病特點及該病治療與預(yù)后的關(guān)系。結(jié)果:本研究共入選314例患者,男性213例(67.8%),女性101例(32.2%),平均年齡為38.59±4.14(29-44)歲。1級高血壓共60(19.11%)例,2級高血壓共109(34.71%)例,3級高血壓共145(46.18%)例。男性青年高血壓病患者約是女性的2倍,3級高血壓患者居多(約占50%);近70%的患者有高血壓病家族史;就生活方式而言,各級青年高血壓病患者都有不同程度的BMI超標(biāo),有吸煙、飲酒等不良生活習(xí)慣,且隨血壓等級升高,吸煙、飲酒、有家族史者所占比例隨之增大;青年高血壓患者均存在血脂、血糖、尿酸等代謝異常,但不同血壓級別之間無差異;伴隨疾病方面,3級高血壓患者約20%的患者有冠心病和缺血性腦卒中,約8%的患者伴有心力衰竭、出血性腦卒中或慢性腎臟病。此外,在治療方面,約20%的患者為單藥治療,發(fā)現(xiàn)其中約40%患者選用CCB,其次為ACEI;約70%的患者需聯(lián)合2種或3種藥物治療,回顧發(fā)現(xiàn),在2、3級青年高血壓患者中,采用ACEI/ARB+β受體阻滯劑+CCB聯(lián)合降壓者居多,多數(shù)治療以β受體阻滯劑為基礎(chǔ)聯(lián)合用藥。經(jīng)積極干預(yù)治療后,絕大多數(shù)青年高血壓患者血壓控制于135/85 mm Hg左右,總膽固醇控制于4.5mmol/L左右,甘油三酯小于1.8mmol/L,低密度脂蛋白均小于2.6mmol/L,高密度脂蛋白均大于1.09mmol/L。在生活方式方面,BMI無明顯變化(干預(yù)前后:24.33±2.42 VS 23.88±1.89),吸煙以及飲酒者減少(治療前后:67.52%VS 59.24%;63.69%VS 51.27%)。藥物治療方面,全部研究對象堅持單藥治療總?cè)藬?shù)顯著增加(18.15%VS 28.34%),其中堅持單藥治療者,1級高血壓患者最顯著(23.33%VS76.67%),2級和3級患者無顯著變化(28.44%VS 28.44%,8.28%VS 8.28%);聯(lián)合用藥總?cè)藬?shù)無顯著變化(67.20%VS 67.20%),聯(lián)合用藥者均為2級或3級高血壓患者。靶器官受損方面,左心室肥厚(25.80%VS 28.03%)、頸動脈硬化(8.60%VS10.83%)、冠心病(15.61%VS 18.15%)略增加,心力衰竭(5.10%VS 6.05%),缺血性腦卒中(14.01%VS 15.29%)、出血性腦卒中(5.10%VS 6.05%)、慢性腎臟病(4.78%VS 5.41%)人數(shù)均稍增加。結(jié)論:(1)青年高血壓發(fā)病多有家族史,男性居多,肥胖體型及生活習(xí)慣不良者更易發(fā)病,同時伴有代謝異常;(2)青年高血壓病患者的治療應(yīng)重視綜合危險因素控制,尤其應(yīng)注意改善不良生活習(xí)慣,選用最佳個體化治療方案,以期最大保護(hù)其靶器官。
[Abstract]:Objective: to analyze retrospectively the diagnosis and treatment of young hypertensive patients in the Department of Cardiology, first Hospital of Shanxi Medical University, and to investigate the relationship between the treatment and prognosis of the young hypertensive patients by following up the out-of-hospital treatment in order to study the incidence characteristics and the relationship between treatment and prognosis of young hypertension. The importance of comprehensive risk control (including drug therapy) for target organ protection was preliminarily elucidated in order to provide some help for clinical work. Methods: from January 2005 to December 2015, 314 patients were diagnosed as young hypertensive patients, who were hospitalized in the Department of Cardiology of the first Hospital of Shanshan University from January 2005 to December 2015. According to the blood pressure level at the first visit, the patients were divided into three groups: grade 1 youth hypertension group, grade 2 youth hypertension group and grade 3 young hypertension group. The data of hospitalization period and related follow-up data of each group were statistically analyzed. To study the characteristics of hypertension in young people and the relationship between the treatment and prognosis. Results: a total of 314 patients (male 213 (67.8%), female 101 (32.2%) were enrolled in this study. The mean age was 38.59 鹵4.14 (29 / 44) years old. There were 60 (19.11%) patients with grade 1 hypertension. There were 109 (34.71%) cases of grade 2 hypertension and 145 (46.18%) cases of grade 3 hypertension. The number of young men with hypertension was about twice as high as that of women, and the majority of grade 3 hypertension patients (about 50%), nearly 70% of them had family history of hypertension. As far as life style is concerned, young hypertensive patients at all levels have different degrees of BMI exceeding the standard, smoking, drinking and other bad living habits, and with the rise of blood pressure grade, smoking, drinking, the proportion of people with family history will increase; There were abnormal metabolism of blood lipid, blood sugar and uric acid in young patients with hypertension, but there was no difference among different blood pressure levels. In terms of disease, about 20% of patients with grade 3 hypertension had coronary heart disease and ischemic stroke, and about 8% had heart failure, hemorrhagic stroke or chronic kidney disease. In addition, in terms of treatment, about 20% of the patients were treated with single drug, and about 40% of the patients were found to use CCB, followed by ACEI;. About 70% of the patients needed two or three kinds of drug therapy. It was found that ACEI/ARB 尾 receptor blocker CCB combined with hypotension was most commonly used in young hypertensive patients of grade 2 and grade 3, and most of the treatments were based on 尾 receptor blocker. After active intervention, the blood pressure, total cholesterol, triglyceride, low density lipoprotein and low density lipoprotein in most young hypertensive patients were about 135 ~ 85 mm Hg, about 4.5mmol/L, 1.8 mmol / L and 2.6 mmol / L, respectively, and the total cholesterol was less than 1.8 mmol / L, and the low density lipoprotein (LDL) was less than 2.6 mmol / L. The high density lipoprotein (HDL) was more than 1.09mmol / L. In terms of life style, there was no significant change in BMI (before and after intervention: 24.33 鹵2.42 VS 23.88 鹵1.89), while smoking and drinking decreased (before and after treatment: 67.52%VS 59.24% vs 63.69% vs 51.27%). In terms of drug therapy, the total number of participants who insisted on single-drug therapy increased significantly (18.15%VS 28.34%), among them, the first-grade hypertension patients (23.33% vs 76.67%) were the most significant among those who insisted on single-drug therapy. There was no significant change in grade 2 and grade 3 patients (28.44%VS 28.44%, 8.28% vs 8.28%). There was no significant change in the total number of patients taking combined drugs (67.20%VS 67.20%). All the patients with combined drugs were grade 2 or grade 3 hypertension. In target organ damage, left ventricular hypertrophy (25.80%VS 28.03%), carotid atherosclerosis (8.60% vs 10.83%), coronary heart disease (15.61%VS 18.15%) and heart failure (5.10%VS 6.05%) increased slightly. Ischemic stroke (14.01%VS 15.29%), hemorrhagic stroke (5.10%VS 6.05%) and chronic kidney disease (4.78%VS 5.41%) increased slightly. Conclusion: (1) the incidence of hypertension in young people has family history, male is the majority, obese body type and poor living habits are more likely to develop, at the same time accompanied by metabolic abnormalities; (2) the treatment of young patients with hypertension should pay attention to the control of comprehensive risk factors, especially to the improvement of bad living habits, and the best individualized treatment scheme should be chosen in order to protect the target organs.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.1
本文編號：2447509
[Abstract]:Objective: to analyze retrospectively the diagnosis and treatment of young hypertensive patients in the Department of Cardiology, first Hospital of Shanxi Medical University, and to investigate the relationship between the treatment and prognosis of the young hypertensive patients by following up the out-of-hospital treatment in order to study the incidence characteristics and the relationship between treatment and prognosis of young hypertension. The importance of comprehensive risk control (including drug therapy) for target organ protection was preliminarily elucidated in order to provide some help for clinical work. Methods: from January 2005 to December 2015, 314 patients were diagnosed as young hypertensive patients, who were hospitalized in the Department of Cardiology of the first Hospital of Shanshan University from January 2005 to December 2015. According to the blood pressure level at the first visit, the patients were divided into three groups: grade 1 youth hypertension group, grade 2 youth hypertension group and grade 3 young hypertension group. The data of hospitalization period and related follow-up data of each group were statistically analyzed. To study the characteristics of hypertension in young people and the relationship between the treatment and prognosis. Results: a total of 314 patients (male 213 (67.8%), female 101 (32.2%) were enrolled in this study. The mean age was 38.59 鹵4.14 (29 / 44) years old. There were 60 (19.11%) patients with grade 1 hypertension. There were 109 (34.71%) cases of grade 2 hypertension and 145 (46.18%) cases of grade 3 hypertension. The number of young men with hypertension was about twice as high as that of women, and the majority of grade 3 hypertension patients (about 50%), nearly 70% of them had family history of hypertension. As far as life style is concerned, young hypertensive patients at all levels have different degrees of BMI exceeding the standard, smoking, drinking and other bad living habits, and with the rise of blood pressure grade, smoking, drinking, the proportion of people with family history will increase; There were abnormal metabolism of blood lipid, blood sugar and uric acid in young patients with hypertension, but there was no difference among different blood pressure levels. In terms of disease, about 20% of patients with grade 3 hypertension had coronary heart disease and ischemic stroke, and about 8% had heart failure, hemorrhagic stroke or chronic kidney disease. In addition, in terms of treatment, about 20% of the patients were treated with single drug, and about 40% of the patients were found to use CCB, followed by ACEI;. About 70% of the patients needed two or three kinds of drug therapy. It was found that ACEI/ARB 尾 receptor blocker CCB combined with hypotension was most commonly used in young hypertensive patients of grade 2 and grade 3, and most of the treatments were based on 尾 receptor blocker. After active intervention, the blood pressure, total cholesterol, triglyceride, low density lipoprotein and low density lipoprotein in most young hypertensive patients were about 135 ~ 85 mm Hg, about 4.5mmol/L, 1.8 mmol / L and 2.6 mmol / L, respectively, and the total cholesterol was less than 1.8 mmol / L, and the low density lipoprotein (LDL) was less than 2.6 mmol / L. The high density lipoprotein (HDL) was more than 1.09mmol / L. In terms of life style, there was no significant change in BMI (before and after intervention: 24.33 鹵2.42 VS 23.88 鹵1.89), while smoking and drinking decreased (before and after treatment: 67.52%VS 59.24% vs 63.69% vs 51.27%). In terms of drug therapy, the total number of participants who insisted on single-drug therapy increased significantly (18.15%VS 28.34%), among them, the first-grade hypertension patients (23.33% vs 76.67%) were the most significant among those who insisted on single-drug therapy. There was no significant change in grade 2 and grade 3 patients (28.44%VS 28.44%, 8.28% vs 8.28%). There was no significant change in the total number of patients taking combined drugs (67.20%VS 67.20%). All the patients with combined drugs were grade 2 or grade 3 hypertension. In target organ damage, left ventricular hypertrophy (25.80%VS 28.03%), carotid atherosclerosis (8.60% vs 10.83%), coronary heart disease (15.61%VS 18.15%) and heart failure (5.10%VS 6.05%) increased slightly. Ischemic stroke (14.01%VS 15.29%), hemorrhagic stroke (5.10%VS 6.05%) and chronic kidney disease (4.78%VS 5.41%) increased slightly. Conclusion: (1) the incidence of hypertension in young people has family history, male is the majority, obese body type and poor living habits are more likely to develop, at the same time accompanied by metabolic abnormalities; (2) the treatment of young patients with hypertension should pay attention to the control of comprehensive risk factors, especially to the improvement of bad living habits, and the best individualized treatment scheme should be chosen in order to protect the target organs.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.1
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