云南省高血压患者外周血管损伤的影响因素分析

Factors affecting peripheral vascular damage in patients with hypertension in Yunnan Province

摘要:

目的 探讨云南省高血压患者外周血管损伤的影响因素。方法 选取2021年1月—2021年12月参与云南省《中国居民心血管病及其危险因素监测》项目并诊断为高血压行四肢血压监测的1 828例患者为研究对象。根据臂踝脉搏波传导速度（baPWV）是否≥ 1 800 mm/s将对象分为动脉硬化组（AS组）和非动脉硬化组（非AS组），分别有522、1 306例。采集患者的年龄、体质量指数（BMI）、腰围、吸烟、饮酒、饮茶、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、尿酸（UA）、肌酐（Cr）、糖化血红蛋白（HbA1c）、葡萄糖（GLU）、血浆肾素浓度（PRC）、血浆醛固酮浓度（PAC）、醛固酮/肾素（ARR）、尿微量白蛋白（UALB）、尿肌酐（Ucr）、尿微量白蛋白/尿肌酐（ACR）、baPWV。采用多因素一般Logistic回归模型分析高血压患者外周血管损伤的影响因素。结果 AS组男性比例、BMI、吸烟、饮茶、DBP较非AS组低（P <0.05），年龄、糖尿病、收缩压（SBP）、较非AS组高（P <0.05）。两组饮酒、腰围比较，差异均无统计学意义（P >0.05）。AS组HbA1C、GLU、HDL-C、LDL-C、TC、Cr、UALB、ACR较非AS组高（P <0.05），Ucr、PRC较非AS组低（P <0.05）。两组TG、UA、PAC、ARR比较，差异无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示：年龄［O^R=1.103（95% CI：1.087，1.120）］、平均SBP［O^R=1.035（95% CI：1.024，1.045）］和Cr［O^R=1.007（95% CI：1.002，1.012）］是导致外周血管损伤的危险因素（P <0.05）。结论 年龄、平均SBP、Cr指标升高可加重高血压患者血管损伤的发生、发展。

Abstract:

Objective To explore the factors affecting peripheral vascular damage in patients with hypertension in Yunnan Province.Methods A total of 1 828 hypertension patients undergoing four-limb blood pressure monitoring enrolled in the program Surveillance of Cardiovascular Disease and its Risk Factors in Chinese Residents carried out in Yunnan Province from January 2021 to December 2021 were selected. According to whether the brachial-ankle pulse wave velocity (baPWV) was ≥ 1 800 mm/s, these participants were divided into the non-arteriosclerosis (AS) group and the AS group, with 1 306 and 522 cases in the two groups, respectively. The age, body mass index (BMI), waist circumference, history of smoking, history of alcohol consumption, history of tea drinking, levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), uric acid (UA), creatine (Cr), glycosylated hemoglobin (HbA1c) and glucose (GLU), plasma renin concentration (PRC), plasma aldosterone concentration (PAC), aldosterone-to-renin ratio (ARR), levels of urine albumin (UALB) and urine creatine (Ucr), urine albumin-creatinine ratio (ACR) and baPWV of patients were collected. Multivariable Logistic regression analysis was performed to determine the factors affecting peripheral vascular damage in patients with hypertension.Results The proportion of males, BMI, proportions of patients with history of smoking and tea drinking, and DBP in the AS group were lower than those in the non-AS group (P < 0.05), while the age, the proportion of patients with diabetes mellitus and SBP in the AS group were higher than those in the non-AS group (P < 0.05). There was no difference in the history of alcohol consumption and waist circumference between the two groups (P > 0.05). The levels of HbA1C, GLU, HDL-C, LDL-C, TC, Cr and UALB as well as the ACR in the AS group were higher than those in the non-AS group (P < 0.05), whereas the level of Ucr and the PRC in the AS group were lower than those in the non-AS group (P < 0.05). There was no difference in levels of TG and UA, PAC or ARR between the two groups (P > 0.05). Multivariable Logistic regression analysis suggested that advanced age [O^R = 1.103 (95% CI: 1.087, 1.120) ], high mean SBP [O^R = 1.035 (95% CI: 1.024, 1.045) ] and high levels of Cr [O^R = 1.007 (95% CI: 1.002, 1.012) ] were risk factors for peripheral vascular damage in patients with hypertension.Conclusions Increases in age, mean SBP and the level of Cr may aggravate the occurrence and development of vascular damage in patients with hypertension.