冠心病合并难治性高血压患者临床特征及其预后

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (609 KB) RICH HTML
输出: BibTeX | EndNote (RIS)

摘要目的探讨冠心病合并难治性高血压患者临床特征及其预后。方法入选1030例合并冠心病的高血压患者,参照难治性高血压的诊断路径,排除引起难治性高血压的继发原因,收集难治性高血压病例,可以控制的高血压病例为对照组,了解该人群难治性高血压临床特征及其预后。临床终点事件包括主要心血管事件:心血管死亡、非致死性心肌梗死、卒中。结果在入选的1030例合并冠心病高血压患者中有88例符合难治性高血压诊断,现患率为8.5%,冠心病合并难治性高血压组心血管事件发生率显著高于对照组。多因素回归分析结果提示,在校正年龄、性别、体重指数、吸烟、基础血压水平、内科合并疾病、内科用药等危险因素后,年龄(OR 1.04,95%CI:1.03～1.05)、体重指数(OR 1.03,95%CI:1.02～1.04)、合并糖尿病(OR 1.70,95%CI:1.52～2.11)、心功能不全(OR 1.25,95%CI:1.52～2.11)为冠心病患者合并难治性高血压的独立危险因素。结论冠心病合并难治性高血压患者较对照组发生心脑血管事件的发病率和病死率明显增高,明确的诊断和有效的治疗至关重要。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张燕
	李炜
	高凌根

关键词 ：冠心病, 难治性高血压, 预后

Abstract：Objective To explore the clinical characteristics and prognosis of patients with resistant hypertension and coronary artery disease.Methods We evaluated 1030 patients with coronary artery disease. According to the currently accepted definition of resistant hypertension, the secondary causes of resistant hypertension were excluded. The primary outcome was major cardiovascular events, including fatal coronary heart disease, nonfatal myocardial infarction and stroke.Results Among the 1030 patients in this study, 88 (8.5%) had apparent resistant hypertension. In a multivariable model adjusting for baseline differences, the resistant hypertension group had an increased primary outcome when compared with the no apparent resistant hypertension group. A multivariate analysis showed that older age, higher BMI, a history of diabetes and chronic heart failure were independent risk factors for resistant hypertension.Conclusions In patients with coronary artery disease, resistant hypertension is associated with a significant increase in the risk of cardiovascular morbidity and mortality. Clear diagnoses and effective treatment are of great importance.

Key words： coronary artery disease resistant hypertension prognosis

收稿日期: 2016-12-17

ZTFLH:	R541.4
	R544.1

通讯作者: 高凌根,gaolinggen@163.com

作者简介: 张燕,本科学历,医师。

引用本文:

张燕, 李炜, 高凌根. 冠心病合并难治性高血压患者临床特征及其预后[J]. 武警医学, 2017, 28(12): 1205-1208. ZHANG Yan, LI Wei, GAO Linggen. Clinical characteristics and prognosis of patients with resistant hypertension and coronary artery disease. Med. J. Chin. Peop. Armed Poli. Forc., 2017, 28(12): 1205-1208.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2017/V28/I12/1205

[1]	陈伟伟,高润霖,刘力生,等.《中国心血管病报告2014》概要 [J].中国循环杂志, 2015,30(7):617-622.
[2]	中国高血压防治指南修订委员会.中国高血压防治指南2010 [J].中华心血管病杂志,2011,39(7):579-616.
[3]	Egan B M, Zhao Y, Axon R N, et al. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008 [J]. Circulation,2011,124(9):1046-1058.
[4]	Daugherty S L, Powers J D, Magid D J, et al. Incidence and prognosis of resistant hypertension in hypertensive patients[J]. Circulation,2012,125(13):1635-1642.
[5]	Persell S D. Prevalence of resistant hypertension in the United States, 2003-2008[J]. Hypertension,2011, 57(6):1076-1080.
[6]	孙宁玲,霍勇,王继光,等.难治性高血压诊断治疗中国专家共识 [J].中国介入心脏病学杂志,2013,21(2):69-74.
[7]	Schmieder R E,Redon J,Grassi G,et al. ESH position paper: renal denervation-an interventional therapy of resistant hypertension [J]. J Hypertens, 2012,30(5):837-841.
[8]	Bakris G L, Townsend R R, Liu M, et al. Impact of renal denervation on 24-hour ambulatory blood pressure:results from symplicity HTN-3 [J]. J Am Coll Cardiol,2014,64(11): 1071-1078.
[9]	Rossi G P, Seccia T M, Maniero C. Drug-related hypertension and resistance to antihypertensive treatment: a call for action [J]. J Hypertens, 2011, 29(12):2295-2309.
[10]	Williams B, MacDonald T M, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2):a randomised, double-blind, crossover trial[J].Lancet,2015,386(10008):2059-2068.
[11]	Sternlicht H, Bakris G L. Spironolactone for resistant hypertension--hard to resist? [J].Lancet, 2015, 386(10008):2032-2034.
[12]	牟建军,何明俊.难治性高血压诊断治疗现状[J].中华高血压杂志 2014,22(1);87-90.
[13]	Cuspidi C, Macca G, Sampieri L, et al. High prevalence of cardiac andextracardiac target organ damage in refractory hypertension[J].J Hypertens, 2001,19(11):2063-2070.
[14]	Kumbhani D J, Steg P G, Cannon C P, et al. Resistant hypertension: afrequent and ominous finding among hypertensive patients with atherothrombosis[J]. Eur Heart J, 2012, 34(16):1204-1214.
[15]	Krum H,Schlaich M,Whitbourn R,et al. Catheter-based renal sympathetic denervation for resistant hypertension:a multicentre safety and proof -of-principle cohort study [J].Lancet, 2009, 373(9671): 1275-1281.
[16]	Esler M D, Krum H, Schlaich M, et al. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the symplicity HTN-2randomized, controlled trial [J] . Circulation, 2012,126(25): 2976-2982.
[17]	Bhatt D L,Kandzari D E,O’Neill W W, et al. A controlled trial of renal denervation for resistant hypertension[J]. N Engl J Med, 2014, 370(15):1393-1401.
[18]	Vink E E, Verloop W L, Bost R B,et al. The blood pressure-lowering effect of renal denervation is inversely related to kidney function[J].J Hypertens, 2014,32(10):2045-2053.
[19]	Persu A, Jin Y, Azizi M, et al. Blood pressure changes after renal denervation at 10 European expert centers [J] .J Hum Hypertens,2014, 28(3):150-156.