接受治疗的高血压患者靶器官损害的患病率：诊室血压控制与动态血压控制的不同影响

Prevalence of target organ damage in treated hypertensive patients: different impact of clinic and ambulatory blood pressure control.

作者信息

Cuspidi C, Lonati L, Sampieri L, Michev I, Macca G, Rocanova J I, Salerno M, Fusi V, Leonetti G, Zanchetti A

机构信息

Istituto di Clinica Medica Generale e Terapia Medica and Centro di Fisiologia Clinica e Ipertensione, Università di Milano and Ospedale Maggiore, Italy.

出版信息

J Hypertens. 2000 Jun;18(6):803-9. doi: 10.1097/00004872-200018060-00020.

DOI:10.1097/00004872-200018060-00020

PMID:10872567

Abstract

OBJECTIVES

First, to evaluate the prevalence of left ventricular (LV) hypertrophy, LV concentric remodelling and microalbuminuria in a selected sample of treated hypertensive patients with effective and prolonged clinic blood pressure (BP) control (BP < 140/90 mmHg). Second, to compare the prevalence of these markers of organ damage in patients with and without ambulatory BP (ABP) control, defined as average daytime BP < 132/85 mmHg).

DESIGN AND METHODS

Fifty-eight consecutive hypertensive patients who attended our hypertension outpatient clinic over a period of 3 months and were regularly followed up by the same medical team were included in the study. Obesity, diabetes mellitus, history or signs of cardiovascular or renal complications and major noncardiovascular diseases were the exclusion criteria from the study. Each patient underwent 24 h ABP monitoring, echocardiography and 24 h urine collection for albumin measurement.

RESULTS

The prevalence of LV hypertrophy (LV mass index > 125 g/m2 in both sexes), LV concentric remodelling (relative wall thickness > 0.45) and microalbuminuria (urinary albumin excretion < 300 mg/ 24 h) in this selected group of patients (32 men, 26 women; mean age 53 +/- 9 years; mean clinic BP 122 +/- 9/ 78 +/- 6 mmHg) was markedly low (6.9, 8.6 and 5.1%, respectively). The 26 patients with effective ABP control (group I) were similar to the 32 patients without effective ABP control (group II) in age, gender, body surface area, clinic BP, smoking habit, glucose, cholesterol and creatinine plasma levels. Prevalence of LV hypertrophy, LV concentric remodelling and microalbuminuria was lower in group I than in group II (0 versus 12.9% P< 0.01, 7.7 versus 9.4% NS, 3.8 versus 6.2% NS, respectively).

CONCLUSIONS

This study demonstrates that nonobese, nondiabetic hypertensive patients with an effective clinic BP control have a very low prevalence of target organ damage and that LVH is present only in individuals with insufficient ABP control.

摘要

目的

第一，评估经过治疗且临床血压得到有效长期控制（血压<140/90 mmHg）的高血压患者样本中左心室（LV）肥厚、LV向心性重构和微量白蛋白尿的患病率。第二，比较动态血压（ABP）得到控制（定义为日间平均血压<132/85 mmHg）和未得到控制的患者中这些器官损伤标志物的患病率。

设计与方法

本研究纳入了连续58例在3个月期间就诊于我们高血压门诊且由同一医疗团队定期随访的高血压患者。肥胖、糖尿病、心血管或肾脏并发症的病史或体征以及主要的非心血管疾病是本研究的排除标准。每位患者均接受24小时ABP监测、超声心动图检查以及24小时尿液收集以测定白蛋白。

结果

在这组选定的患者（32例男性，26例女性；平均年龄53±9岁；平均临床血压122±9/78±6 mmHg）中，LV肥厚（男女LV质量指数>125 g/m²）、LV向心性重构（相对壁厚度>0.45）和微量白蛋白尿（尿白蛋白排泄<300 mg/24小时）的患病率显著较低（分别为6.9%、8.6%和5.1%）。26例ABP得到有效控制的患者（第一组）在年龄、性别、体表面积、临床血压、吸烟习惯、血糖、胆固醇和肌酐血浆水平方面与32例ABP未得到有效控制的患者（第二组）相似。第一组中LV肥厚、LV向心性重构和微量白蛋白尿的患病率低于第二组（分别为0%对12.9%，P<0.01；7.7%对9.4%，无显著差异；3.8%对6.2%，无显著差异）。