高血压急症和高血压门诊患者中高血压介导的心血管器官损害
Cardiovascular Hypertension-Mediated Organ Damage in Hypertensive Urgencies and Hypertensive Outpatients.
作者信息
Vallelonga Fabrizio, Cesareo Marco, Menon Leonardo, Airale Lorenzo, Leone Dario, Astarita Anna, Mingrone Giulia, Tizzani Maria, Lupia Enrico, Veglio Franco, Milan Alberto
机构信息
Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
Division of Emergency Medicine, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
出版信息
Front Cardiovasc Med. 2022 May 16;9:889554. doi: 10.3389/fcvm.2022.889554. eCollection 2022.
BACKGROUND
The prevalence of hypertension mediated organ damage (HMOD) in patients attending the Emergency Department (ED) with symptomatic blood pressure (BP) rise is unknown, and whether HMOD varies between asymptomatic and symptomatic patients with grade 3 hypertension is unclear.
AIM
This study aimed to investigate cardiac and vascular HMOD in hypertensive urgencies (HU) and asymptomatic outpatients with grade 1-3 hypertension.
METHODS
Patients attending the ED with a symptomatic BP rise ≥180/110 mmHg were prospectively enrolled (HU group), after the exclusion of acute organ damage. HMOD and BP were assessed after 72 h from ED discharge in an office setting. These patients were matched by age and sex to outpatients with grade 3 hypertension (Grade 3 group), and by age, sex, and 72 h office BP values to outpatients with any grade hypertension (Control group).
RESULTS
A total of 304 patients were enrolled (76 patients in the HU group, 76 in the Grade 3 group, and 152 in the Control group). Grade 3 patients had increased left ventricular mass (LVMi) compared to patients with HU (106.9 ± 31.5 vs. 96.1 ± 30.7 g/m, = 0.035). Severe left ventricular hypertrophy (LVH) was more frequent in grade 3 (21.1 vs. 5.3%, = 0.004), and pulse wave velocity (PWV) was similar in the two groups. There was no difference in LVMi between ED and Control patients (96.1 ± 30.7 vs. 95.2 ± 26.6 g/m, = 0.807). LVH prevalence was similar (43.4 vs. 35.5%, = 0.209, respectively), but patients with HU had thicker interventricular septum (11.9 ± 2.2 vs. 11.1 ± 2.2 mm, = 0.007). PWV was similar between these two groups. Patients with HU needed more antihypertensive drugs than Control patients (2 vs. 1, < 0.001).
CONCLUSIONS
Patients with HU had a better cardiac HMOD profile than outpatients with grade 3 hypertension. Their cardiac and vascular HMOD is more comparable to an outpatient with similar in-office BP, although they need more antihypertensive medications.
背景
急诊科（ED）中因症状性血压（BP）升高就诊的患者中高血压介导的器官损害（HMOD）的患病率尚不清楚，且3级高血压无症状和有症状患者之间的HMOD是否存在差异也不明确。
目的
本研究旨在调查高血压急症（HU）患者以及1 - 3级高血压无症状门诊患者的心脏和血管HMOD情况。
方法
前瞻性纳入ED中症状性BP升高≥180/110 mmHg的患者（HU组），排除急性器官损害。在出院72小时后于门诊环境中评估HMOD和BP。将这些患者按年龄和性别与3级高血压门诊患者匹配（3级组），并按年龄、性别和72小时门诊BP值与任何级高血压门诊患者匹配（对照组）。
结果
共纳入304例患者（HU组76例，3级组76例，对照组152例）。与HU患者相比，3级患者的左心室质量（LVMi）增加（106.9±31.5 vs. 96.1±30.7 g/m²，P = 0.035）。3级患者中重度左心室肥厚（LVH）更常见（21.1% vs. 5.3%，P = 0.004），两组脉搏波速度（PWV）相似。ED患者和对照组患者的LVMi无差异（96.1±30.7 vs. 95.2±26.6 g/m²，P = 0.807）。LVH患病率相似（分别为43.4% vs. 35.5%，P = 0.209），但HU患者的室间隔更厚（11.9±2.2 vs. 11.1±2.2 mm，P = 0.007）。这两组之间PWV相似。HU患者比对照组患者需要更多的降压药物（2种 vs. 1种，P < 0.001）。
结论
HU患者的心脏HMOD情况优于3级高血压门诊患者。尽管他们需要更多的降压药物，但其心脏和血管HMOD情况与门诊BP相似的患者更具可比性。
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