Boivin J-M, Koch C, Vigié L, Meppiel L
Département de médecine générale de Nancy, université de Lorraine, 54505 Vandœuvre-lès-Nancy cedex, France; CIC-P Inserm, Meurthe et Moselle, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France.
Daiichi Sankyo, 92500 Rueil-Malmaison, France.
Ann Cardiol Angeiol (Paris). 2015 Jun;64(3):150-7. doi: 10.1016/j.ancard.2015.04.006. Epub 2015 Jun 3.
To compare the percentages of men and women treated for primary arterial hypertension presenting with at least one target organ damage; to identify factors associated with target organ damage and/or blood pressure control.
Observational, transverse study carried out between March 2012 and July 2013 on a representative sample of 2666 outpatients (including 1343 men) consulting general practitioners (n=469) or cardiologists (n=250) in routine follow-up.
Characteristics "men vs. women" were: mean age (62.6 ± 11.6 vs. 57.4 ± 14.7 years; P<0.0001); ≥ 60 years (61.1% vs. 43.9%; P<0.0001); waist circumference (98.9 ± 12.2 vs. 89.4 ± 14.3 cm; P<0.0001); SBP (146.5 ± 16.1 vs. 145.8 ± 17.0 mmHg; NS); DBP (85.1 ± 10.3 vs. 84.2 ± 10.4; P=0,03). Target organ damage was more frequent in men (37.6% vs. 22.9%; P<0.0001), whether it was subclinical (20.4% vs. 13.6%; P<0.0001) or documented (26.3% vs. 13.5%; P<0.0001); some patients presented with both types of damages. Men developed more often microalbuminuria (6.5% vs. 4.3%; P=0.01) and LVH (16.3% vs. 10.5%; P<0.0001); some patients presented with both types of subclinical injuries. Target organ damage was more common in men without regular physical activity than in those exercising regularly (42.1% vs. 32.5%; P=0.0004). Regular exercises had no effect in women (24.1% vs. 21.3%). For both sexes, other factors associated with target organ damage were: age ≥ 60 years, myocardial infarction/sudden death in family history, LDL-cholesterol ≥ 1.60 g/L, HDL-cholesterol ≤ 0.40 g/L. Stroke before 45 years in family history was a predictive factor in women. Hypertension was controlled in one third of patients without difference between sexes. In women, hypertension was less often controlled in case of excessive alcohol consumption compared to normal alcohol intake (17.9% vs. 36.1%; P=0.0007); this factor had no effect in men (28.1% vs. 32.6%). Other factors associated with poor blood pressure control were: BMI (P=0.002), LDL-cholesterol ≥ 1.60 g/L in women. In men, the factors were: tobacco, presence of LVH, absence of physical activity, HDL-cholesterol ≤ 0.40 g/L, absence of diet.
In a hypertensive population, target organ damage is more common among men despite similar blood pressure control rates for both sexes.
比较因原发性动脉高血压接受治疗且出现至少一种靶器官损害的男性和女性的比例；确定与靶器官损害和/或血压控制相关的因素。
2012年3月至2013年7月对2666名门诊患者（包括1343名男性）的代表性样本进行观察性横断面研究，这些患者在常规随访中咨询全科医生（n = 469）或心脏病专家（n = 250）。
“男性与女性”的特征如下：平均年龄（62.6±11.6岁对57.4±14.7岁；P<0.0001）；≥60岁（61.1%对43.9%；P<0.0001）；腰围（98.9±12.2厘米对89.4±14.3厘米；P<0.0001）；收缩压（146.5±16.1毫米汞柱对145.8±17.0毫米汞柱；无显著差异）；舒张压（85.1±10.3对84.2±10.4；P = 0.03）。男性靶器官损害更常见（37.6%对22.9%；P<0.0001），无论是亚临床损害（20.4%对13.6%；P<0.0001）还是有记录的损害（26.3%对13.5%；P<0.0001）；一些患者同时存在两种类型的损害。男性更常出现微量白蛋白尿（6.5%对4.3%；P = 0.01）和左心室肥厚（16.3%对10.5%；P<0.0001）；一些患者同时存在两种类型的亚临床损伤。与定期进行体育活动的男性相比，未定期进行体育活动的男性靶器官损害更常见（42.1%对32.5%；P = 0.0004）。定期锻炼对女性没有影响（24.1%对21.3%）。对于两性而言，与靶器官损害相关的其他因素有：年龄≥60岁、家族中有心肌梗死/猝死、低密度脂蛋白胆固醇≥1.60克/升、高密度脂蛋白胆固醇≤0.40克/升。家族中有45岁之前的中风史是女性的一个预测因素。三分之一的患者血压得到控制，两性之间无差异。在女性中，与正常饮酒量相比，过量饮酒时高血压得到控制的情况较少（17.9%对36.1%；P = 0.0007）；该因素对男性没有影响（28.1%对32.6%）。与血压控制不佳相关的其他因素有：体重指数（P = 0.002），女性低密度脂蛋白胆固醇≥1.60克/升。在男性中，这些因素有：吸烟、存在左心室肥厚、缺乏体育活动、高密度脂蛋白胆固醇≤0.40克/升、未控制饮食。
在高血压人群中，尽管两性血压控制率相似，但男性靶器官损害更为常见。
