Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China.
J Clin Hypertens (Greenwich). 2023 Apr;25(4):350-359. doi: 10.1111/jch.14651. Epub 2023 Mar 17.
There is currently few research on clinical characteristics and outcomes of coronary heart disease (CHD) with resistant hypertension in central region of China. This study aimed to assess the risk factors and outcomes of CHD and resistant hypertension in population of central region of China. A total of 1467 CHD patients with hypertension were included and considered to three groups according to blood pressure control: controlled group (blood pressure < 140/90 mmHg on three or less antihypertensive drugs); uncontrolled group (blood pressure ≥ 140/90 mmHg on two or less antihypertensive drugs); or resistant group (blood pressure ≥ 140/90 mmHg on three antihypertensive drugs or < 140/90 mmHg on at least four antihypertensive drugs including diuretic). The authors evaluated the clinical outcomes of three groups at 1-year follow-up. The prevalence of resistant hypertension was 21.8%. Significant adjusted associated factors of resistant hypertension included per unit changes body mass index (BMI, OR 1.12), and four categorical variable diagnosis by yes or no: heart failure (HF, OR 2.62), left ventricular hypertrophy (LVH, OR 2.83), diabetes (OR 1.55), and chronic kidney disease (CKD, OR 1.63). In multiple adjusted Cox regression analysis, patients in resistant group had a higher risk of the primary outcome (HR, 2.14 [95% CI, 1.47-3.11]; p < .001). Moreover, the risk of atherosclerotic cardiovascular disease (ASCVD) in patients with resistant hypertension is also significantly increased (HR, 2.11 [95% CI, 1.39-3.20]; p < .001). In conclusion, resistant hypertension was a quite common and high proportion finding in patients with CHD and hypertension in central region of China, and these patients have a worse clinical prognosis.
目前，针对中国中部地区合并难治性高血压的冠心病（CHD）的临床特征和结局的研究较少。本研究旨在评估中国中部地区人群中 CHD 和难治性高血压的危险因素和结局。共纳入 1467 例高血压合并 CHD 患者，根据血压控制情况将其分为三组：控制组（血压<140/90mmHg，使用三种或以下降压药物）；未控制组（血压≥140/90mmHg，使用两种或以下降压药物）；或难治组（血压≥140/90mmHg，使用三种降压药物或至少四种降压药物<140/90mmHg，包括利尿剂）。作者评估了三组患者在 1 年随访时的临床结局。难治性高血压的患病率为 21.8%。难治性高血压的显著校正相关因素包括单位体重指数（BMI）变化（OR 1.12）和四个二分类变量：心力衰竭（HF，OR 2.62）、左心室肥厚（LVH，OR 2.83）、糖尿病（OR 1.55）和慢性肾脏病（CKD，OR 1.63）。在多因素调整 Cox 回归分析中，难治组患者的主要结局（HR，2.14[95%CI，1.47-3.11]；p<0.001）风险更高。此外，合并难治性高血压的患者发生动脉粥样硬化性心血管疾病（ASCVD）的风险也显著增加（HR，2.11[95%CI，1.39-3.20]；p<0.001）。综上所述，在中国中部地区，合并难治性高血压的 CHD 和高血压患者中，难治性高血压是一种相当常见且比例较高的现象，这些患者的临床预后更差。
