继发性高血压患者的病因构成及其发生难治性高血压的影响因素研究OA
Etiological Composition of Patients with Secondary Hypertension and the Influencing Factors of Refractory Hypertension
目的 探讨继发性高血压患者的病因构成及其发生难治性高血压的影响因素.方法 连续纳入2024年11月—2025年11月武汉大学人民医院高血压科收治的391例继发性高血压患者为研究对象.收集患者的临床资料,根据是否符合难治性高血压诊断标准将患者分为难治性高血压组73例与非难治性高血压组318例.采用单因素及多因素Logistic回归分析探讨继发性高血压患者发生难治性高血压的影响因素.结果 391例继发性高血压患者病因:原发性醛固酮增多症(PA)142例(占36.32%),阻塞性睡眠呼吸暂停综合征(OSA)123例(占31.46%),肾血管性高血压46例(占11.76%),肾实质性高血压22例(占5.63%),混合病因21例(占5.37%),其他病因37例(占9.46%).难治性高血压组合并心力衰竭者占比、血浆醛固酮、血管紧张素Ⅱ(AngⅡ)、血尿酸高于非难治性高血压组(P＜0.05);两组病因比较,差异有统计学意义(P＜0.05).单因素Logistic回归分析结果显示,心力衰竭、肾素活性、血肌酐、估算肾小球滤过率(eGFR)、血尿酸、病因可能是继发性高血压患者发生难治性高血压的影响因素(P＜0.05);多因素Logistic回归分析结果显示,心力衰竭、ARR、肾素活性、血尿酸、病因是继发性高血压患者发生难治性高血压的独立影响因素(P＜0.05).结论 PA、OSA是继发性高血压患者的主要病因;心力衰竭、ARR、肾素活性、血尿酸、病因是继发性高血压患者发生难治性高血压的独立影响因素.
Objective To investigate the etiological composition of patients with secondary hypertension and the influencing factors of refractory hypertension.Methods A total of 391 patients with secondary hypertension admitted to the Department of Hypertension of Renmin Hospital of Wuhan University from November 2024 to November 2025 were continuously selected as the research subjects.The clinical data of the patients were collected,and the patients were divided into refractory hypertension group(n=73)and non-refractory hypertension group(n=318)according to whether they conformed to the diagnostic criteria for refractory hypertension.Univariate and multivariate Logistic regression analyses were used to explore the influencing factors of refractory hypertension in patients with secondary hypertension.Results The etiology of 391 patients with secondary hypertension was primary aldosteronism(PA)in 142 cases(36.32%),obstructive sleep apnea(OSA)in 123 cases(31.46%),renovascular hypertension in 46 cases(11.76%),renal parenchymal hypertension in 22 cases(5.63%),mixed etiologies in 21 cases(5.37%),and other causes in 37 cases(9.46%).The proportion of patients with heart failure,plasma aldosterone,angiotensin Ⅱ(AngⅡ),and serum uric acid in the refractory hypertension group were higher than those in the non-refractory hypertension group(P<0.05).There was a statistically significant difference in etiology between the two groups(P<0.05).Univariate Logistic regression analysis showed that heart failure,renin activity,serum creatinine,estimated glomerular filtration rate(eGFR),serum uric acid,and etiology may be influencing factors for refractory hypertension in patients with secondary hypertension(P<0.05).Multivariate Logistic regression analysis showed that heart failure,ARR,renin activity,serum uric acid,and etiology were independent influencing factors for refractory hypertension in patients with secondary hypertension(P<0.05).Conclusion PA and OSA are the predominant etiologies of patients with secondary hypertension.Heart failure,ARR,renin activity,serum uric acid,and etiology are independent influencing factors for refractory hypertension in patients with secondary hypertension.
沈梦瑶;周晓阳
430060 湖北省武汉市,武汉大学人民医院心血管内科430060 湖北省武汉市,武汉大学人民医院心血管内科
医药卫生
高血压继发性高血压难治性高血压影响因素分析
HypertensionSecondary hypertensionRefractory hypertensionRoot cause analysis
《实用心脑肺血管病杂志》 2026 (7)
19-24,6
国家自然科学基金资助项目(81970331)
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