Grajek S, Cieśliński A, Mitkowski P, Ochotny R, Pawlak B, Brocki Z, Ponizyński A, Lehman Z, Paradowski S
Institute of Cardiology, University of Medical Sciences Poznań, Poland.
J Hum Hypertens. 1995 Dec;9(12):987-92.
The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II.
patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.
本研究的目的是分析合并主动脉夹层的高血压患者门诊治疗的结果。20例患者（19例男性，1例女性），年龄在39至72岁之间，接受了全面的体格检查。所有病例均通过至少两种不同的影像学方法（超声检查、数字减影血管造影、计算机断层扫描或核磁共振）确诊为主动脉夹层。在随访期间（3至75个月，平均34.3个月），每6至8周进行一次体格检查，每年进行一次胸部X光检查。所有患者在家中自行监测血压。根据每月家庭血压测量的平均次数，将所有患者分为两组：I组依从性良好（n = 10）和II组依从性差（n = 10）（每月家庭血压测量次数分别为28±30次和3±2次）。10例患者（I组6例，II组4例）进行了24小时自动血压测量检查。采集血样检测血清胆固醇和尿酸。所有患者均患有高血压，其中5例患者至少有一位父母患有此病。20例患者中只有3例从不吸烟。10例（50%）患者血清胆固醇升高，6例（30%）患者尿酸升高。13例患者为近端（A型）主动脉夹层（DeBakey分类I型和II型），7例患者为远端主动脉夹层（B型）。所有患者均接受β受体阻滞剂治疗。20例患者中有75%同时使用三种或更多降压药物来控制血压。I组患者的最大收缩压平均值较低（160±10 vs 177±7 mmHg，P < 0.05），昼夜平均心率较低（58.6±7.5 vs 80.9±7.9次/分钟，P < 0.005）。最常见的症状是间歇性跛行，9例（45%）；心绞痛8例（40%），其他胸痛4例（20%）。在随访期间（3至75个月，平均34.3个月），20例患者中有5例（25%）死亡（均为近端A型夹层），20例患者中有15例（75%）仍存活。II组所有死亡均为猝死, 而I组仅1例死于慢性肾功能不全。I组和II组的死亡率分别为10%（1/10）和40%（4/10）。
更频繁监测血压的患者血压值和心率更低，因此预后更好。
