诊断学理论与实践

诊断学理论与实践 ›› 2025, Vol. 24 ›› Issue (04): 449-454.doi: 10.16150/j.1671-2870.2025.04.012

• 论著 • 上一篇    下一篇

原发性醛固酮增多症中难治性高血压患者的临床特征分析

马毓, 吴祁红, 亢园园, 洪墨纳, 唐晓峰, 高平进, 许建忠(), 王继光   

  1. 上海交通大学医学院附属瑞金医院高血压科，上海市高血压研究所，上海 200025
  • 收稿日期:2024-12-04 修回日期:2025-03-06 接受日期:2025-06-08 出版日期:2025-08-25 发布日期:2025-09-09
  • 通讯作者: 许建忠 E-mail：jianzhongxv@outlook.com
  • 基金资助:
    国家自然科学基金(U21A20354);上海市卫健委青年基金(20214Y0229)

Analysis of clinical characteristics of patients with resistant hypertension in primary aldosteronism

MA Yu, WU Qihong, KANG Yuanyuan, HONG Mona, TANG Xiaofeng, GAO Pingjin, XU Jianzhong(), WANG Jiguang   

  1. Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Hypertension, Shanghai 200025, China
  • Received:2024-12-04 Revised:2025-03-06 Accepted:2025-06-08 Published:2025-08-25 Online:2025-09-09

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摘要：

目的：比较原发性醛固酮增多症（primary aldosteronism，PA）和原发性高血压（essential hypertension，EH）患者中难治性高血压（resistant hypertension，RH）的临床特征，分析RH的危险因素。方法：收集2010年1月至2014年12月在我院就诊查高血压原因的2 138例连续高血压患者，统计RH患病率，并将其中385例（18.0%）患者为PA组，同时匹配年龄、性别、血压水平一致的385例EH患者（EH组），比较2组中的RH患病率、一般临床资料，分析PA、EH患者中RH与左心室肥厚（left ventricular hypertrophy， LVH）间的关系，采用多元线性回归分析预测RH的危险因素。结果：RH在高血压科住院患者中约占26.0%（556/2 138），而RH患者中有9.2%（51/556）为PA患者。PA组中RH患病率明显低于EH组（13.2%比35.3%，P<0.001）。在PA组中RH患者与非RH患者间的LVH的发生率无统计学差异（59.3%比56.9%）；在EH组中，RH患者的LVH发生率远高于非RH的患者（54.3%比30.1%，P<0.05）。多元回归分析显示，诊室收缩压水平、男性及糖尿病是PA患者发生RH的独立危险因素。EH组RH的发生，与年龄、高血压病程、LVH及肌酐水平独立相关（P<0.05）。结论：在住院高血压患者中，RH患病率约为26.0%，在血压水平相当的PA患者和EH患者中，RH在EH患者中的患病率更高，而LVH在PA患者中的发生率更高，与其是否为RH无关。EH组中，RH患者的LVH发生率高于非RH患者。诊室收缩压、男性及罹患糖尿病可预测PA是否为RH的因素。

关键词: 难治性高血压, 原发性醛固酮增多症, 原发性高血压

Abstract:

Objective To compare the clinical characteristics of resistant hypertension (RH) in patients with primary aldosteronism (PA) and essential hypertension (EH), and to analyze the risk factors associated with RH. Methods From January 2010 to December 2014, a total of 2 138 consecutive patients referred to our department for screening the causes of hypertension were enrolled. The prevalence of RH was calculated. Among them, 385 patients (18.0%) were classified into the PA group, and 385 patients with EH matched based on age, gender, blood pressure (BP) levels were selected as the EH group. The prevalence of RH and general clinical data between the two groups were compared, and the relationship between RH and left ventricular hypertrophy (LVH) in patients with PA and EH was analyzed. Multiple linear regression analysis was used to identify risk factors for RH. Results RH accounted for approximately 26.0% (556/2 138) of the inpatients in the department of hypertension, and 9.2% (51/556) of these RH patients were diagnosed with PA. The prevalence of RH in the PA group was significantly lower than that in the EH group (13.2% vs 35.3%, P<0.001). There was no significant difference in the incidence of LVH between RH and non-RH patients in the PA group (59.3% vs 56.9%). In the EH group, the incidence of LVH was much higher in RH patients than in non-RH patients (54.3% vs 30.1%, P<0.05). Multivariate regression analysis showed that office systolic blood pressure, male gender, and diabetes were independent risk factors for RH in PA patients. The occurrence of RH in the EH group was independently correlated with age, hypertension course, LVH, and creatinine level (P<0.05). Conclusions The prevalence of RH among hypertensive inpatients is approximately 26.0%. In PA and EH patients with comparable BP levels, the prevalence of RH is higher in EH patients, while the incidence of LVH is higher in PA patients and is not related to the presence of RH. In the EH group, RH patients have a higher incidence of LVH than non-RH patients. Office systolic blood pressure, male gender, and diabetes are important predictive factors for RH in PA patients.

Key words: Resistant hypertension, Primary aldosteronism, Essential hypertension

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