天津市城区成年高血压患者亚临床靶器官损害的流行病学特征及其与肾素-血管紧张素-醛固酮系统的关系

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

作者信息

Li Yong-le, Wan Zheng, Sun Yue-Min, Lu Wen-Li, Yao Wei, Yu Xue-Fang, Wang Yuan, Wang Jian-Hua

机构信息

Department of Cardiology, General Hospital, Tianjin Medical University, Tianjin 300052, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2011 Feb 15;91(6):415-9.

PMID:21418917

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 m(2))(-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.

摘要

目的

探讨天津市城区成年高血压患者亚临床靶器官损害（TOD）的流行病学特征，并评估其与循环肾素 - 血管紧张素 - 醛固酮系统（RAAS）的关系。

方法

对天津市城区成年居民进行流行病学调查。对单纯性高血压患者进行随访，检查靶器官受累情况，包括左心室肥厚（LVH）、颈动脉斑块或内膜中层增厚（IMT）、微量白蛋白尿（MAU）和估算肾小球滤过率（eGFR）。采用多因素logistic回归分析评估亚临床TOD与RAAS之间的关系。

结果

共有1547例单纯性高血压患者接受了进一步的靶器官受累情况检查。LVH、颈动脉斑块、颈动脉IMT、MAU和eGFR<60 ml×min⁻¹×(1.73 m²)⁻¹的患病率分别为37.7%、38.2%、35.4%、33.7%和4.4%。根据是否存在一种、两种或三种TOD标志物，患病率分别为20.5%、34.7%、33.7%和11.1%。根据logistic回归分析，在调整年龄、性别、当前吸烟、当前饮酒、既往降压治疗、体重指数、平均收缩压、平均舒张压、高血压病程及其他危险因素后，血浆肾素活性（OR 0.870，95%CI 0.791 - 0.958，P = 0.005）和血浆血管紧张素II（OR 1.005，95%CI 1.001 - 1.009，P = 0.021）水平与LVH独立相关，血清醛固酮水平与颈动脉IMT或斑块（OR 毛1.025，95%CI 1.000 - 1.050，P = 0.048）和MAU（OR 1.049，95%CI 1.024 - 1.074，P < 0.001）独立相关。