Clinical value of multiorgan damage in hypertensive crises: A prospective follow-up study
Clinical value of multiorgan damage in hypertensive crises: A prospective follow-up study
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高血压危象多器官损害的临床价值：一项前瞻性随访研究
DOI：
10.1111/jch.13848
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发表时间：
2020
影响因子：
2.8
通讯作者：
Zhang Wen
中科院分区：
文献类型：
--
作者：
Ma Hongkun;Jiang Mengdi;Fu Zongjie;Wang Zhiyu;Shen Pingyan;Shi Hao;Feng Xiaobei;Chen Yongxi;Ding Xiaoyi;Wu Zhiyuan;Zhang Wen
高血压危象与靶器官并发症的高发生率和不良结局相关。最近从恶性高血压的定义转变为高血压-多器官损害（MOD）有助于高血压危象的诊断和管理。在此，我们前瞻性纳入了166例患有高血压危象（血压>180/120 mm Hg）的成人（≥18岁）患者。评估靶器官和高血压的原因。被诊断为恶性高血压视网膜病变、没有恶性高血压视网膜病变但存在至少3个器官的损害以及没有视网膜病变和MOD的患者分别被分类为恶性高血压（n = 48）、高血压-MOD（n = 42）和高血压无MOD（n = 76）组。对患者进行随访，以评估肾脏和心血管疾病。基线时，恶性高血压患者的肾功能更差，白蛋白尿水平更高，微血管损伤比高血压-MOD患者更严重。两人的恶性小动脉肾硬化（83%对64%）、左心室肥大（90%对88%）、异常复极（71%对60%）和左心室功能障碍（12%对21%）的比例相似。在20个月的随访中，恶性高血压和高血压-MOD组的血压控制率和蛋白尿相似。两组的肾脏预后均比无MOD的高血压组差（P= 0.002）。在调整年龄、性别、血压和蛋白尿控制后，高血压-MOD患者（HR = 0.67，[95% CI：0.30 - 1.46]，P= 0.31）的无肾脏事件生存期与MHT患者相似。这些结果表明，在高血压危象中，恶性高血压和高血压-MOD均对不良肾脏结局产生影响。
Hypertensive crises are associated with high rates of target organ complications and poor outcomes. A recent shift from the definition of malignant hypertension to hypertension‐multiorgan damage (MOD) contributes to the diagnosis and management of hypertensive crises. Here, we prospectively included 166 adult (≥18 years old) patients with hypertensive crises (blood pressure >180/120 mm Hg). Target organs and causes of hypertension were assessed. Patients who were diagnosed with malignant hypertensive retinopathy, the absence of malignant hypertensive retinopathy but the presence of damage to at least 3 organs, and the absence of both retinopathy and MOD were classified as the malignant hypertension (n = 48), hypertension‐MOD (n = 42), and hypertension without MOD (n = 76) groups, respectively. Patients were followed to evaluate renal and cardiovascular prognoses. At baseline, patients with malignant hypertension had worse renal function, higher level of albuminuria, and more severe microvascular damage than those with hypertension‐MOD. Both had similar proportions of malignant arteriolar nephrosclerosis (83% vs 64%), left ventricular hypertrophy (90% vs 88%), abnormal repolarization (71% vs 60%), and left ventricular dysfunction (12% vs 21%). At the twenty months of follow‐up, both the malignant hypertension and hypertension‐MOD groups had similar blood pressure control rates and proteinuria. Both groups had worse renal outcomes than the hypertension without MOD group (P= .002). Patients with hypertension‐MOD (HR = 0.67, [95% CI: 0.30‐1.46],P= .31) had similar renal event‐free survival than patients with MHT after adjustments of age, sex, blood pressure, and proteinuria control. These results suggest that in hypertensive crises, both malignant hypertension and hypertension‐MOD have impact on adverse renal outcomes.