胸痛患者三种不同诊断标准的运动性高血压患病率和影响因素分析及其对靶器官损害的影响  

The Prevalence and Risk Factors and Impacts on Target Organ Damage of Exercise Hypertension Diagnosed by Three Diagnostic Criteria in Patients With Suspected Chest Pain

作　　者：苏艳东 杨海涛 陈晓胜 何佳[3] 樊晓寒[3] SU Yandong;YANG Haitao;CHEN Xiaosheng;HE Jia;FAN Xiaohan(Department of Cardiology,Zhengzhou University People's Hospital,Henan Provincial People's Hospital Heart Center,Fuwai Central China Cardiovascular Hospital,Zhengzhou 451464,China;Department of Cardiology,The Fifth Affilated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]郑州大学人民医院河南省人民医院心脏中心阜外华中心血管病医院心内科,郑州451464 [2]郑州大学第五附属医院心内科,郑州450052 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京100037

出　　处：《中国循环杂志》2023年第11期1157-1163,共7页Chinese Circulation Journal

摘　　要：目的:通过分析胸痛患者进行平板运动试验的血压数据,探讨运动性高血压在该人群中的患病率和可能的影响因素及其对靶器官损害的影响。方法:连续回顾性收集2021年6月至2022年6月在阜外华中心血管病医院行平板运动试验检查的胸痛患者的临床资料。根据国际上运动性高血压三种常见的诊断标准[美国心脏协会(AHA)标准、Dlin标准和弗雷明汉心脏研究(FHS)标准],比较运动性高血压的患病率及在不同亚组中的分布情况,并比较不同诊断标准下运动性高血压人群左心室肥厚的患病率。结果:共纳入1 254例患者,平均年龄(51.0±10.0)岁,其中女性477例(38.0%)。AHA标准、Dlin标准和FHS标准运动性高血压的患病率分别为29.2%、29.8%和11.6%。进一步分析发现,在体重指数(BMI)≥28.0 kg/m^(2)及有高血压病史的人群中三种诊断标准下的运动性高血压患病率均显著升高。多因素Logistic回归分析显示,BMI≥28.0kg/m^(2)和高血压病史与三种不同诊断标准诊断的运动性高血压都有显著的相关性(P均<0.05)。AHA标准、Dlin标准和FHS标准下运动性高血压和非运动性高血压人群的左心室肥厚患病率分别为11.5%vs. 8.0%(P=0.050)、10.7%vs.8.3%(P=0.175)和15.2%vs. 8.2%(P=0.006)。多因素Logistic回归分析显示,FHS标准下的运动性高血压不是左心室肥厚的独立影响因素(P=0.988)。结论:BMI≥28.0 kg/m^(2)和(或)有高血压病史的胸痛患者更容易发生运动性高血压,更需要警惕运动性高血压带来的危害。在评估对左心室肥厚等靶器官损害的影响时,推荐应用FHS标准诊断运动性高血压。Objectives:To explore the prevalence of exercise hypertension,possible risk factors and impact on target organ damage by analyzing the blood pressure data of treadmill exercise test in patients with chest pain.Methods:The clinical data of consecutive patients with suspected chest pain,who underwent treadmill exercise test in Fuwai Central China Cardiovascular Hospital from June 2021 to June 2022,were retrospectively collected.Exercise hypertension was diagnosed by three diagnostic criteria,the prevalence of left ventricular hypertrophy between exercise hypertension and non-exercise hypertension under different diagnostic standards was compared.Results:A total of 1254 patients were enrolled,average age was(51.0±10.0)years,and 477(38.0%)were female.According to American Heart Association(AHA)standard,Dlin standard and Framingham Heart Study(FHS)standard,the prevalence of exercise-induced hypertension was 29.2%,29.8%and 11.6%respectively.Subgroup analysis found that the prevalence of exercise hypertension of the three diagnostic criteria was significantly increased in people with body mass index(BMI)≥28.0 kg/m^(2) and a history of hypertension.Multivariate logistic regression analysis showed that BMI≥28.0 kg/m^(2) and hypertension history were significantly correlated with exercise hypertension defined by the three different criteria(all P<0.05).The prevalence rates of left ventricular hypertrophy in exercise hypertension group and non-exercise hypertension group under AHA,Dlin and FHS standards were 11.5%vs.8.0%(P=0.050),10.7%vs.8.3%(P=0.175)and 15.2%vs.8.2%(P=0.006),respectively.Multivariate logistic regression analysis showed that exercise hypertension diagnosed by FHS criteria was not an independent influencing factor of left ventricular hypertrophy(P=0.988).Conclusions:Patients with suspected chest pain with BMI≥28.0g kg/m^(2) and/or a history of hypertension are more likely to develop exercise hypertension,and target organ damage should be evaluated and efforts should be made to minimize the harmful imp

关 键 词：运动性高血压 运动性高血压反应 运动性过度血压反应 高体重指数 高血压 靶器官损害 

分 类 号：R54[医药卫生—心血管疾病]