天津市区成人高血压患者亚临床靶器官损害的流行病学特征及与血清醛固酮水平的关系
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摘要
目的了解天津市区成人高血压及其亚临床靶器官损害(target organ damage, TOD)的流行病学特征,探讨亚临床TOD与血清醛固酮水平的关系。
方法采用多阶段随机抽样的方法,在天津市内6个行政区,每个区内随机抽取2个社区卫生服务中心,再随机选取每个中心下辖的2-3个小区,对小区内成人居民进行问卷调查和体格检查。对无已知临床合并症的高血压患者进行亚临床TOD[左心室肥厚(left ventricular hypertrophy, LVH),颈动脉内-中膜厚度(carotid intima-media thickness, IMT)增厚或斑块,微量白蛋白尿(microalbuminuria, MAU)和估算的肾小球滤过率(estimated glomerular filtration rate, eGFR)]的评估。采用Logistic回归分析亚临床TOD与血浆肾素活性、血管紧张素Ⅱ和血清醛固酮水平的关系。
结果高血压患病率为27.5%,标化患病率为17.2%。男、女性患病率分别为27.6%,27.5%,差别无统计学意义。各年龄组间高血压患病率差别有统计学意义(男：χ2=2012.412,P=0.000；女：χ2=3 148.872,P=0.000；χ2=5 091.616,P=0.000)。男、女性高血压患病率均随BMI增加而上升(男：χ2=628.622,P=0.000；女：χ2=1275.525,P=0.000)。文化程度越高高血压患病率越低(男,χ2=413.368,P=0.000,女,χ2=1339.858,P=0.000)。吸烟人群高血压患病率高于非吸烟人群(男,χ2=19.129,P=0.000,女,χ2=146.605,P=0.000)。高血压知晓率、治疗率和控制率分别为65.8%,53.1%和14.9%。1547例无临床合并症的高血压患者参加了亚临床TOD的评估,LVH、颈动脉斑块、颈动脉IMT增厚、MAU和eGFR <60 ml·min-1·(1.73 m2)-1的患病率分别为37.7%、38.2%、35.4%、33.7%和4.4%；颈动脉斑块和/或颈动脉IMT增厚的患病率最高为52.8%。共有1509例患者完成了所有亚临床TOD的评估,其中20.5%的患者无TOD、34.7%有1个TOD、33.7%有2个TOD,11.1%有3个TOD。Logistic回归分析显示,在校正年龄、性别、目前吸烟、目前饮酒、高血压治疗史、体质指数、平均收缩压、平均舒张压、高血压持续时间等因素后,血浆血管紧张素Ⅱ水平(OR 1.005,95% CI 1.001～1.009, P=0.021)、肾素活性水平(OR 0.870,95%CI0.791-0.958, P=0.005)与LVH独立相关,血清醛固酮水平与颈动脉IMT增厚或斑块(OR 1.025, 95% CI 1.000～1.050, P=0.048)及MAU (OR 1.049,95%CI 1.024-1.074, P< 0.001)独立相关。
结论(1)天津市区成人高血压患病率相对较低,知晓率和治疗率较高,但控制率仍有待提高。(2)天津市区成人高血压患者亚临床TOD是相当普遍的。(3)高血压患者亚临床TOD存在聚集现象。(4)IMT增厚或斑块的患病率最高,在我国颈动脉超声检查尤为重要。(5)MAU对肾功能早期损害的评估可能有更大的价值。(6)RAAS尤其是醛固酮在高血压亚临床TOD中发挥重要作用。
Objective This study was to investigate the epidemiological characteristics of hypertension and subclinical target organ damage (TOD) among urban adult residents in Tianjin and to evaluate the relationship of serum aldosterone level with subclinical TOD.
Methods Using a multi-stage random sampling method, two community health service centers were selected from each urban administrative district of Tianjin, and two or three districts were randomly selected from each center. Individuals aged 18 and over were investigated with questionnaire and physical examination. Participants with uncomplicated hypertension were invited for further investigations to examine for target organ involvement, including left ventricular hypertrophy (LVH), carotid plaque or intima-media thickening (IMT), microalbuminuria (MAU) and estimated glomerular filtration rate (eGFR). Logistic regression was used to evaluate the relations between subclinical TOD and serum aldosterone level.
Resu I ts A total of 7852 persons with hypertension were screened out in 28515 target objects. The prevalence of hypertension was 27.5% and standardized rate was 17.2%. The prevalence rates were 27.6% in males and 27.5% in females, but the difference was not statistically significant. The prevalence of hypertension was significantly different among the age groups (male:x2=2012.412,p=0.000; female:x2=3 148.872, P=0.000;x2=5091.616, P=0.000). In both males and females prevalence of hypertension was increased with increasing BMI (male:x2=628.622, P=0.000; female:x2=1275.525, P=0.000). Patients with higher levels of education had a lower prevalence of hypertension (male,x2=413.368, P=0.000, female,x2=1339.858, P=0.000). Hypertension prevalence rate among smokers was higher than in non-smokers (male,x2=19.129, P=0.000, female,x2=146.605, P=0.000). Hypertension awareness, treatment, and control rates were 65.8%,53.1% and 14.9% respectively. A total of 1547 subjects with uncomplicated hypertension underwent further investigations to examine for target organ involvement. The prevalence rates of LVH, carotid plaques, carotid IMT, MAU and eGFR<60 ml-min-1·(1.73 m2)-1 were 37.7%,38.2%,35.4%,33.7% and 4.4%, respectively. In the whole population, the most common phenotype of TOD was carotid plaque and/or carotid IMT (52.8%). The prevalence rates of the patients categorized according to the absence or the presence of one marker, two or three markers of TOD were 20.5%,34.7%,33.7% and 11.1%, respectively. According to the logistic regression analysis adjusting for age, gender, current smoking, current drinking, previous antihypertensive treatment, body mass index, mean systolic blood pressure, mean diastolic blood pressure, duration of hypertension and other risk factors, plasma renin activity (OR 0.870,95% CI 0.791～0.958, P= 0.005) and plasma angiotensinⅡ(OR 1.005,95%CI 1.001-1.009, P= 0.021) levels were independently associated with LVH, serum aldosterone level was independently associated with carotid IMT or plaque (OR 1.025,95% CI 1.000-1.050, P= 0.048) and MAU (OR 1.049,95% CI 1.024-1.074, P<0.001).
Conclusion (1) There were a lower prevalence of hypertension, higher rates of hypertension awareness and treatment, but the hypertension control rate was still unsatisfactory in Tianjin. (2) Subclinical TOD is fairly common among urban adult residents with hypertension in Tianjin. (3) Hypertensive related damage in one organ may be associated with similar alterations in other organs. (4) The most common phenotype of TOD was carotid plaque and/or carotid IMT (52.8%). Carotid ultrasound check is very important in china. (5) MAU may have greater value for early detection of renal dysfunction. (6) RAAS, especially serum aldosterone, plays an important role in the pathogenesis of subclinical TOD.
方法采用多阶段随机抽样的方法,在天津市内6个行政区,每个区内随机抽取2个社区卫生服务中心,再随机选取每个中心下辖的2-3个小区,对小区内成人居民进行问卷调查和体格检查。对无已知临床合并症的高血压患者进行亚临床TOD[左心室肥厚(left ventricular hypertrophy, LVH),颈动脉内-中膜厚度(carotid intima-media thickness, IMT)增厚或斑块,微量白蛋白尿(microalbuminuria, MAU)和估算的肾小球滤过率(estimated glomerular filtration rate, eGFR)]的评估。采用Logistic回归分析亚临床TOD与血浆肾素活性、血管紧张素Ⅱ和血清醛固酮水平的关系。
结果高血压患病率为27.5%,标化患病率为17.2%。男、女性患病率分别为27.6%,27.5%,差别无统计学意义。各年龄组间高血压患病率差别有统计学意义(男：χ2=2012.412,P=0.000；女：χ2=3 148.872,P=0.000；χ2=5 091.616,P=0.000)。男、女性高血压患病率均随BMI增加而上升(男：χ2=628.622,P=0.000；女：χ2=1275.525,P=0.000)。文化程度越高高血压患病率越低(男,χ2=413.368,P=0.000,女,χ2=1339.858,P=0.000)。吸烟人群高血压患病率高于非吸烟人群(男,χ2=19.129,P=0.000,女,χ2=146.605,P=0.000)。高血压知晓率、治疗率和控制率分别为65.8%,53.1%和14.9%。1547例无临床合并症的高血压患者参加了亚临床TOD的评估,LVH、颈动脉斑块、颈动脉IMT增厚、MAU和eGFR <60 ml·min-1·(1.73 m2)-1的患病率分别为37.7%、38.2%、35.4%、33.7%和4.4%；颈动脉斑块和/或颈动脉IMT增厚的患病率最高为52.8%。共有1509例患者完成了所有亚临床TOD的评估,其中20.5%的患者无TOD、34.7%有1个TOD、33.7%有2个TOD,11.1%有3个TOD。Logistic回归分析显示,在校正年龄、性别、目前吸烟、目前饮酒、高血压治疗史、体质指数、平均收缩压、平均舒张压、高血压持续时间等因素后,血浆血管紧张素Ⅱ水平(OR 1.005,95% CI 1.001～1.009, P=0.021)、肾素活性水平(OR 0.870,95%CI0.791-0.958, P=0.005)与LVH独立相关,血清醛固酮水平与颈动脉IMT增厚或斑块(OR 1.025, 95% CI 1.000～1.050, P=0.048)及MAU (OR 1.049,95%CI 1.024-1.074, P< 0.001)独立相关。
结论(1)天津市区成人高血压患病率相对较低,知晓率和治疗率较高,但控制率仍有待提高。(2)天津市区成人高血压患者亚临床TOD是相当普遍的。(3)高血压患者亚临床TOD存在聚集现象。(4)IMT增厚或斑块的患病率最高,在我国颈动脉超声检查尤为重要。(5)MAU对肾功能早期损害的评估可能有更大的价值。(6)RAAS尤其是醛固酮在高血压亚临床TOD中发挥重要作用。
Objective This study was to investigate the epidemiological characteristics of hypertension and subclinical target organ damage (TOD) among urban adult residents in Tianjin and to evaluate the relationship of serum aldosterone level with subclinical TOD.
Methods Using a multi-stage random sampling method, two community health service centers were selected from each urban administrative district of Tianjin, and two or three districts were randomly selected from each center. Individuals aged 18 and over were investigated with questionnaire and physical examination. Participants with uncomplicated hypertension were invited for further investigations to examine for target organ involvement, including left ventricular hypertrophy (LVH), carotid plaque or intima-media thickening (IMT), microalbuminuria (MAU) and estimated glomerular filtration rate (eGFR). Logistic regression was used to evaluate the relations between subclinical TOD and serum aldosterone level.
Resu I ts A total of 7852 persons with hypertension were screened out in 28515 target objects. The prevalence of hypertension was 27.5% and standardized rate was 17.2%. The prevalence rates were 27.6% in males and 27.5% in females, but the difference was not statistically significant. The prevalence of hypertension was significantly different among the age groups (male:x2=2012.412,p=0.000; female:x2=3 148.872, P=0.000;x2=5091.616, P=0.000). In both males and females prevalence of hypertension was increased with increasing BMI (male:x2=628.622, P=0.000; female:x2=1275.525, P=0.000). Patients with higher levels of education had a lower prevalence of hypertension (male,x2=413.368, P=0.000, female,x2=1339.858, P=0.000). Hypertension prevalence rate among smokers was higher than in non-smokers (male,x2=19.129, P=0.000, female,x2=146.605, P=0.000). Hypertension awareness, treatment, and control rates were 65.8%,53.1% and 14.9% respectively. A total of 1547 subjects with uncomplicated hypertension underwent further investigations to examine for target organ involvement. The prevalence rates of LVH, carotid plaques, carotid IMT, MAU and eGFR<60 ml-min-1·(1.73 m2)-1 were 37.7%,38.2%,35.4%,33.7% and 4.4%, respectively. In the whole population, the most common phenotype of TOD was carotid plaque and/or carotid IMT (52.8%). The prevalence rates of the patients categorized according to the absence or the presence of one marker, two or three markers of TOD were 20.5%,34.7%,33.7% and 11.1%, respectively. According to the logistic regression analysis adjusting for age, gender, current smoking, current drinking, previous antihypertensive treatment, body mass index, mean systolic blood pressure, mean diastolic blood pressure, duration of hypertension and other risk factors, plasma renin activity (OR 0.870,95% CI 0.791～0.958, P= 0.005) and plasma angiotensinⅡ(OR 1.005,95%CI 1.001-1.009, P= 0.021) levels were independently associated with LVH, serum aldosterone level was independently associated with carotid IMT or plaque (OR 1.025,95% CI 1.000-1.050, P= 0.048) and MAU (OR 1.049,95% CI 1.024-1.074, P<0.001).
Conclusion (1) There were a lower prevalence of hypertension, higher rates of hypertension awareness and treatment, but the hypertension control rate was still unsatisfactory in Tianjin. (2) Subclinical TOD is fairly common among urban adult residents with hypertension in Tianjin. (3) Hypertensive related damage in one organ may be associated with similar alterations in other organs. (4) The most common phenotype of TOD was carotid plaque and/or carotid IMT (52.8%). Carotid ultrasound check is very important in china. (5) MAU may have greater value for early detection of renal dysfunction. (6) RAAS, especially serum aldosterone, plays an important role in the pathogenesis of subclinical TOD.
引文
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