Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence
Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence
复制标题
DOI：
10.1007/s00392-010-0148-4
复制
发表时间：
2010-08-01
影响因子：
5
通讯作者：
Muegge, Andreas
中科院分区：
文献类型：
--
作者：
Boergel, Jan;Springer, Stephanie;Muegge, Andreas
高血压急症频繁发生，但没有关于睡眠呼吸暂停（SA）、肾动脉狭窄（RAS）和醛固酮增多症等常见继发性原因的前瞻性数据。纳入了在急诊室就诊超过1年、收缩压<180 mmHg和/或舒张压<100 mmHg且有典型症状的患者。RAS通过肾动脉的直接双功/多普勒超声、阻力指数和成像诊断。醛固酮/肾素比值（ARR）测定从早晨血液样本采取的患者仰卧后千分之一日元2小时的休息。ARR阳性（> 50）后输注生理盐水以排除原发性醛固酮增多症。通过鼻呼吸流量筛查评估SA;当阳性[呼吸暂停/低通气指数（AHI）> 5/h]时，进行完整的多导睡眠图。（年龄，66.0 +/- A 13.1岁; BMI，28.6 +/- A 5.1 kg），131例既往确诊为高血压（持续时间，12.7 +/- A 11.5年; 1.9 +/- A 1.5抗高血压药物）。114例（70.8%）患者发现SA [18%轻度（AHI：5-15/h），26.8%中度（15.1-30/h），24.2%重度（> 30/h）]。23例醛固酮增多症患者中有22例醛固酮水平超过160 pg/ml，其中4例为原发性醛固酮增多症，12例为继发性醛固酮增多症。13例（8.1%）患者有RAS。1例患者（0.6%）发现了3个次要原因，25例患者（15.5%）发现了千分之一日元2，124例患者（77.0%）发现了千分之一日元1。在150个检测到的次要原因中，只有5个是以前认识到的。高血压的次要原因是常见的，主要是在高血压急症患者中未被认识到的。次要原因的共患病率约为15%，应在治疗干预前考虑。
Hypertensive urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available.Patients presenting to the emergency room for over 1 year with systolic blood pressure a parts per thousand yen180 mmHg and/or diastolic blood pressure a parts per thousand yen100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after a parts per thousand yen2 h of rest. A positive ARR (> 50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) > 5/h], complete polysomnography was performed.Of 161 patients (age, 66.0 +/- A 13.1 years; BMI, 28.6 +/- A 5.1 kg), 131 had previously identified hypertension (duration, 12.7 +/- A 11.5 years; 1.9 +/- A 1.5 antihypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5-15/h), 26.8% moderate (15.1-30/h), and 24.2% severe (> 30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), a parts per thousand yen2 in 25 (15.5%), and a parts per thousand yen1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously.Secondary causes of hypertension are common and predominantly unrecognized in patients with hypertensive urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.