高血压患者RAAS活性及其对降压治疗的影响

发布时间：2018-09-04 06:36

【摘要】：研究目的:探讨中国原发性高血压患者血浆肾素-血管紧张素-醛固酮系统(RAAS)活性水平,以及该系统活性与原发性高血压患者靶器官损害的相关性,并研究应用检测血浆肾素、血管紧张素II、醛固酮活性水平调整降压药物对降压治疗的影响。研究方法:按照纳入标准入选2012年6月至2014年12月期间入住我院心血管内科的原发性高血压患者共504例,男性186例,女性318例。应用横断面调查及前瞻性队列研究的方法,收集患者临床资料:年龄、性别、既往最高血压等级、高血压病程、是否有糖尿病、冠心病、脑血管意外等病史。检测患者低密度脂蛋白胆固醇(LDL-C)、尿酸、血肌酐、基础血浆肾素活性(PRA)、血管紧张素II(Ang II)、醛固酮(ALD)水平,通过头颅CT等检查患者是否有脑卒中,颈动脉多普勒查颈动脉斑块情况、心脏超声了解是否存在左心室肥厚。应用logistic回归分析的方法,纳入PRA、Ang II、ALD、年龄、性别、血压等级、高血压病程、尿酸、LDL-C等因素进行分析,筛选出脑卒中、颈动脉斑块、左心室肥厚、肾损害发生的危险因素。另外,患者在住院期间,根据不同RAAS活性水平调整治疗方案:对于PRA、Ang II升高的患者优先选用ACEI、ARB,对于ALD升高的患者优先选用醛固酮受体拮抗剂,PRA、Ang II不高的患者优先选用CCB、噻嗪类利尿剂,详细记录患者入院前及根据PRA、Ang II、ALD水平调整降压用药的情况。在出院时分析患者的血压达标情况;分析达标患者的选药情况,以评价通过检测RAAS活性调整降压方案对降压治疗的影响。研究结果:1.本研究入选的高血压患者共有504例,年龄19~95(69.97±12.50)岁,其中男性186例,女性318例。2.患者PRA、Ang II、ALD活性水平升高的比例依次为21.9%、15.3%、24.9%,总体RAAS活性水平不高。3.分组比较中,与PRA不高组相比,高PRA组中患者高血压病程较短(7.30±5.67 vs 9.31±8.05,P0.05)、男性较多(47.9%vs 34.2%,P0.05);与ALD不高组相比,高ALD组中高血压患者年龄较年轻(70.84±12.07 vs 67.07±13.46,P0.01)、LDL-C水平较高(3.16±1.19 vs 2.88±1.06,P0.05)。4.相关性分析结果显示PRA、ALD与年龄负相关,而PRA、Ang II及ALD三者均与LDL-C正相关。5.Logistics回归分析显示PRA升高是LVH独立危险因素(OR=2.42,95%CI:1.32~4.42,P0.05),也是脑血管疾病的独立危险因素(OR=2.88,95%CI:1.45~5.70,P0.05)。6.本研究高血压用药中随着RAAS等级的升高,血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)、醛固酮拮抗剂的使用逐渐增加,而利尿剂、钙离子拮抗剂(CCB)的使用逐渐减少,总体药物选择类型与RAAS水平相符,患者出院血压达标率为93.7%,获得理想降压效果。研究结论:1.本研究显示原发性高血压人群RAAS水平普遍不高。2.年龄与ALD水平负相关,LDL-C与RAAS活性正相关。3.高血压患者发生LVH的独立危险因素包括高PRA、既往最高血压等级,Ang II和ALD水平与LVH未见明显关系;脑卒中的独立危险因素包括高PRA、入院最高血压等级及高龄,Ang II和ALD水平与脑卒中无明显关系;高血压患者发生颈动脉斑块事件的独立影响因素包括性别、高血压病程及高龄,而RAAS水平与颈动脉斑块发生未见明显关系;高血压患者发生肾损害的独立危险因素包括高尿酸、高血压病程及高龄,而RAAS水平与肾损害发生未见明显关系。4.根据RAAS活性检测结果指导降压治疗能获得理想降压效果。
[Abstract]:OBJECTIVE: To investigate the plasma renin-angiotensin-aldosterone system (RAAS) activity and its correlation with target organ damage in patients with essential hypertension in China, and to study the effect of antihypertensive drugs on antihypertensive therapy by detecting plasma renin, angiotensin II and aldosterone activity. Methods: A total of 504 patients with essential hypertension, 186 males and 318 females, were enrolled in the Department of cardiovascular medicine from June 2012 to December 2014 according to the inclusion criteria. The levels of low density lipoprotein cholesterol (LDL-C), uric acid, serum creatinine, basic plasma renin activity (PRA), angiotensin II (Ang II), aldosterone (ALD) were measured. The patients were examined for stroke by CT, carotid plaque by carotid artery Doppler, and cardiac ultrasonography. The risk factors of stroke, carotid plaque, left ventricular hypertrophy and renal damage were screened by logistic regression analysis, including PRA, Ang II, ALD, age, sex, blood pressure, hypertension course, uric acid and LDL-C. ACEI and ARB were preferred for patients with elevated PRA and Ang II, aldosterone receptor antagonists were preferred for patients with elevated ALD, CCB and thiazide diuretics were preferred for patients with low PRA and Ang II, and the antihypertensive drugs were recorded in detail before admission and according to PRA, Ang II and ALD levels. Results: 1. A total of 504 hypertensive patients, aged 19-95 (69.97 + 12.50) years, including 186 males and 318 females, were enrolled in this study. Compared with the low PRA group, the hypertension course of the high PRA group was shorter (7.30 9.31 6550 The results of correlation analysis showed that PRA and ALD were negatively correlated with age, while PRA, Ang II and ALD were positively correlated with LDL-C. 5. Logistic regression analysis showed that the increase of PRA was an independent risk factor for LVH (OR = 2.42, 95% CI: 1.32-4.42, P 0.05). Risk factors (OR = 2.88, 95% CI: 1.45-5.70, P 0.05). 6. With the increase of RAAS grade, the use of angiotensin converting enzyme inhibitor (ACEI) / angiotensin receptor antagonist (ARB) and aldosterone antagonist gradually increased, while the use of diuretics, calcium antagonist (CCB) gradually decreased, and the overall type of drug selection in hypertension. In accordance with the RAAS level, the rate of blood pressure reaching the standard was 93.7%, and the ideal hypotensive effect was obtained. Conclusion: 1. The RAAS level was generally low in essential hypertension. 2. Age was negatively correlated with ALD level, and LDL-C was positively correlated with RAAS activity. 3. The independent risk factors of LVH in hypertension patients included high PRA, past highest blood pressure and so on. Levels of Ang II and ALD had no significant correlation with LVH; independent risk factors for stroke included high PRA, the highest blood pressure level and age at admission, and there was no significant correlation between Ang II and ALD levels and stroke; independent risk factors for carotid plaque events in hypertensive patients included gender, hypertension duration and age, while RAAS levels and carotid plaque. The independent risk factors of renal impairment in hypertensive patients include hyperuricemia, hypertension course and age, while the level of RAAS has no significant relationship with the occurrence of renal impairment.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1

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