依据血流动力学特征指导高血压治疗用药的可行性探索  

Feasibility exploration on hypertension treatment guided with hemodynamic profiling

作　　者：王鲁雁[1] 王鸿懿[1] 顾坚磊 马政 张之瀛 孙宁玲[1] Wang Luyan;Wang Hongyi;Gu Jianlei;Ma Zheng;Zhang Zhiying;Sun Ningling(Hypertension Research Room,Peking University People’s Hospital,Beijing 100044,China;Biostatistics and Data Science,The SJTU-Yale Joint Center,Shanghai 200240,China;Department of Cardiology,Beijing Puhua International Hospital,Beijing 100050,China)

机构地区：[1]北京大学人民医院高血压研究室,100044 [2]上海交通大学-耶鲁大学生物统计与数据科学联合中心,200240 [3]北京天坛普华医院心内科,100050

出　　处：《中国心血管杂志》2021年第5期432-437,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探索依据血流动力学表型指导降压药物选择的可行性。方法采用前瞻性单中心随机单盲对照研究方法,纳入102例初发未治疗或经治疗血压未达标(≥140/90 mmHg)的高血压患者。采用阻抗心动图(ICG)检查采集血流动力学指标,并分为依据血流动力学治疗组(A组,51例)和常规经验治疗组(B组,51例),治疗4~12周,主要疗效指标为两组的诊室血压下降幅度。结果与B组比较,A组收缩压[(19.9±10.7)mmHg比(12.0±11.8)mmHg]和舒张压[(11.3±6.2)mmHg比(4.9±9.9)mmHg]较基线降幅更大,A组达标率更高(66.7%比41.2%)(均为P<0.05)。男性、年龄<50岁、经治、基线收缩压<160 mmHg、基线舒张压≥90 mmHg亚组中,A组血压达标率均高于B组(均为P<0.05)。A组患者中,β受体阻滞剂用药后的心排指数较基线显著下降(P=0.044),利尿剂用药后胸腔血容量饱和度显著降低(P=0.001),钙通道拮抗剂使用后大动脉硬化指数(P=0.003)和系统血管阻力指数(P=0.003)均较基线明显降低,而肾素血管紧张素系统抑制剂类药物使用后系统血管阻力指数显著降低(P<0.001)。结论使用血流动力学检查协助判断未控制的高血压患者可能的血压升高机制,并以此为依据选择降压药物可能更有效地降低血压,并提高降压达标率。Objective To investigate the feasibility of the selection of antihypertensive drugs guided with hemodynamic phenotypes.Methods This was a prospective,single-center,randomized,single-blind controlled study.A total of 102 patients with newly diagnosed,untreated hypertension or uncontrolled(≥140/90 mmHg)hypertension were enrolled.Impedance cardiogram(ICG)was used to collect hemodynamic indicators.All patients were divided into hemodynamic treatment group(group A,51 cases)and conventional empirical treatment group(group B,51 cases).The patients received the treatment for 4-12 weeks,and the primary outcome was the decrease degree of office blood pressure.Results Compared with group B,reduction degree of systolic blood pressure[(19.9±10.7)mmHg vs.(12.0±11.8)mmHg]and diastolic blood pressure[(11.3±6.2)mmHg vs.(4.9±9.9)mmHg]was significantly greater in group A.Compliance rate was higher in group A(66.7%vs.41.2%)(all P<0.05).In the subgroups of males,<50 years old,post-treatment,baseline systolic blood pressure<160 mmHg,baseline diastolic blood pressure≥90 mmHg,blood pressure compliance rate in group A was higher than that of group B(all P<0.05).In group A,theβ-blocker usage was associated with significantly lower cardiac output index than baseline(P=0.044),diuretic usage was associated with decreased thoracic blood volume saturation(P=0.001),calcium channel antagonist usage was associated with lower arteriosclerosis index(P=0.003)and the system vascular resistance index(P=0.003),and renin angiotensin system inhibitor was associated with lower system vascular resistance index(P<0.001).Conclusions Hemodynamic profiling can be useful in determining the possible mechanisms in patients with uncontrolled hypertension.ICG-guided selection of antihypertensive drugs may be more effective in reducing blood pressure and improving blood pressure control rate than empirical drug selection.

关 键 词：高血压 血流动力学 药物治疗 阻抗心动图 

分 类 号：R544.1[医药卫生—心血管疾病]