运动高血压患者的动脉弹性和尿微量白蛋白/肌酐值的分析  

Study of arterial elasticity and value of microalbuminuria/creatinine in patients with hypertensive response to exercise

作　　者：王雁 朱利月[1] 任爱华[1] 

机构地区：[1]浙江医院高血压中心,杭州市310013

出　　处：《中华全科医学》2015年第8期1241-1243,共3页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2010KYA027)

摘　　要：目的对于静息血压控制正常的原发性高血压患者中运动血压异常升高者,分析以动脉弹性和尿微量白蛋白/肌酐值为代表的靶器官病变情况,并简要评价其降压药物使用情况。方法根据运动平板试验,以运动峰值收缩压≥200 mm Hg为诊断标准,分为运动高血压组[n=48,男性33例,女性15例,年龄(64.7±7.1)岁]和运动血压正常组[n=53,男性36例,女性17例,年龄(61.0±6.4)岁],用心-踝血管指数(CAVI)作为反映大动脉弹性的指标,分别测定2组患者的心踝指数、尿微量白蛋白/肌酐值;并分析2组间降压及他汀类药物使用情况。结果1与运动中血压反应正常组相比,出现运动高血压患者中,肥胖、吸烟史、高Hb A1c、高LDL、合并脑卒中比例明显增多,服用他汀药物比例减少(P<0.05)。2运动高血压组患者CAVI、尿微量白蛋白/肌酐値显著大于运动血压正常组[(10.61±0.78)m/s vs.(9.03±0.91)m/s,P<0.05;(3.98±1.11)mg/mmol vs.(2.30±0.53)mg/mmol,P<0.05];3运动高血压组钙离子拮抗剂(CCB)、血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)的联合使用比例(33.3%vs.39.6%)低于运动血压正常组,差异有统计学意义(P<0.05)。结论运动血压异常升高的患者其靶器官病变更显著,CCB与ACEI/ARB的联合使用对运动血压的控制作用较强。Objective To investigate the artery elastic and the value of microalbuminuria / creatinine in patients with hypertensive response to exercise,and evaluate the using of antihypertensive drugs. Methods Patients with well-controlled essential hypertension were divided into hypertensive response group（ peak exercise systolic blood pressure≥200 mm Hg,n = 48） and normal response group（ peak exercise systolic blood pressure 200 mm Hg,n = 53） according to peak SBP after sub-maximal treadmill exercise test. Cardio-ankle vascular index and the value of microalbuminuria / creatinine were be compared,application of antihypertensive and statins drugs were analyzed and compared between the two groups. Results ①There was significant difference in age,BMI,LDL-C,Hb A1 c,smoking,stroke,taking statin between two groups（P 〈0. 05）;②There were significant differences（ P 〈0. 05） between 2 groups in both Cardio-ankle vascular index[（9. 03 ± 0. 91） m/s vs.（10. 61 ± 0. 78）m/s]and the value of microalbuminuria/creatinine[（2. 30 ± 0. 53） mg/mmol vs.（3. 98 ± 1. 11） mg / mmol];③Significant higher ratio of normal blood pressure response to exercise group is taking more than 2 types antihypertensive drug（39. 6% vs. 33. 3%,P 〈0. 05） when compared to patients in hypertensive response to exercise group. Conclusion More severe damage in target organ was found in hypertensive response to exercise patients,combined use of calcium channel blocker（ CCB）,angiotensin convert enzymeinhibitor（ ACEI） and angiotensin receptor blockers（ ARB） have positive effect on control blood pressure response to exercise.

关 键 词：运动高血压 平板运动试验 动脉弹性 尿微量白蛋白/肌酐 

分 类 号：R544.1[医药卫生—心血管疾病]