Yaméogo N V, Samadoulougou A K, Kagambèga L J, Millogo G R C, Yaméogo A A, Kologo K J, Ilboudo E, Kaboré E, Mandi G, Kombasséré K, Toguyeni B J Y, Pignatelli S, Simporé J, Zabsonré P
Service de cardiologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou, Burkina Faso.
Service de cardiologie, CHU Yalgado Ouédraogo, 03 BP 7022, Ouagadougou, Burkina Faso.
Ann Cardiol Angeiol (Paris). 2014 Apr;63(2):83-8. doi: 10.1016/j.ancard.2014.01.002. Epub 2014 Jan 21.
Few studies in sub-Saharan Africa were interested in resistant hypertension. The objectives of this study were to determine the frequency of resistant hypertension in hypertensive black African population, and to describe its clinical and therapeutic features.
From May 1, 2010 to May 31, 2012, we included consecutively hypertensive followed in two hospitals in the city of Ouagadougou, under antihypertensive treatment at optimum dose and observant. Patients whose blood pressure was uncontrolled despite a triple antihypertensive therapy at the optimal dose including a diuretic associated with dietary measures have received ambulatory blood pressure monitoring. Following this examination, patients whose blood pressure was ≥135/85mmHg during the day and/or ≥120/70mmHg at night were considered resistant hypertension. We investigated the cardiovascular risk factors as well as target organ damages. We combined spironolactone 50mg in treatment when absence of contra-indication appreciated the evolution of blood pressure under this treatment. The measurement of plasma renin activity was not performed. Statistical analysis was performed using SPSS Version 17 for Windows.
We included 692 patients with 14.6% of resistant hypertension. The average age of patients was 54.8±11.1years in the general population, 56.5±11.8years in the subgroup of non-resistant hypertension and 64.2±5.4years in the subgroup of resistant hypertension. The symptoms were represented by headache (11.9%), dizziness (9.9%) and chest pain (8.9%). Modifiable cardiovascular risk factors were dominated by dyslipidemia, diabetes and obesity/overweight. These risk factors were significantly more frequent in the subgroup of resistant hypertension. The global cardiovascular risk was high in 24.9% of cases in the general population, 22.5% in the subgroup of non-resistant hypertension and 38.6% in the subgroup of resistant hypertension. The target organ damages were significantly more frequent in the same subgroup of resistant hypertension. After addition of spironolactone, 21.8% of resistant hypertensive patients were controlled.
This study shows that resistant hypertension is common in black Africans. It is mostly subjects of the sixth decade, with limited economic income and living in rural areas. In the absence of contra-indication, spironolactone contributed to decrease the morbidity of this pathology.
撒哈拉以南非洲地区很少有研究关注难治性高血压。本研究的目的是确定高血压黑人非洲人群中难治性高血压的发生率，并描述其临床和治疗特征。
从2010年5月1日至2012年5月31日，我们连续纳入了在瓦加杜古市两家医院接受治疗的高血压患者，这些患者接受了最佳剂量的抗高血压治疗且依从性良好。尽管采用了包括利尿剂及饮食措施在内的最佳剂量三联抗高血压治疗，但血压仍未得到控制的患者接受了动态血压监测。经过此项检查，白天血压≥135/85mmHg和/或夜间血压≥120/70mmHg的患者被视为难治性高血压。我们调查了心血管危险因素以及靶器官损害情况。在无禁忌证的情况下，联合使用50mg螺内酯进行治疗，并观察此治疗方案下血压的变化。未进行血浆肾素活性测定。使用Windows版SPSS 17进行统计分析。
我们纳入了692例患者，其中难治性高血压患者占14.6%。总体人群中患者的平均年龄为54.8±11.1岁，非难治性高血压亚组中为56.5±11.8岁，难治性高血压亚组中为64.2±5.4岁。症状表现为头痛（11.9%）、头晕（9.9%）和胸痛（8.9%）。可改变的心血管危险因素以血脂异常、糖尿病和肥胖/超重为主。这些危险因素在难治性高血压亚组中更为常见。总体人群中24.9%的病例全球心血管风险高，非难治性高血压亚组中为22.5%，难治性高血压亚组中为38.6%。靶器官损害在难治性高血压同一亚组中更为常见。添加螺内酯后，21.8%的难治性高血压患者血压得到控制。
本研究表明难治性高血压在非洲黑人中很常见。患者大多为60岁左右，经济收入有限且居住在农村地区。在无禁忌证的情况下，螺内酯有助于降低这种疾病的发病率。
