Correlation of exercise hypertension with arteriosclerosis and early renal damage in patients with essential hypertension
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摘要:
目的 探讨原发性高血压患者中运动性高血压与动脉硬化及早期肾损害的关系。 方法 选择原发性高血压患者105例，根据Bruce方案行次极量跑台运动负荷试验，依据次极量运动时收缩压（SBP）分为运动性高血压组（次极量运动时SBP≥200 mmHg，H组）和运动血压正常组（次极量运动时SBP<200 mmHg，N组），两组分别为46例和59例，均行血脂、肾功能、血糖、高敏C-反应蛋白（hs-CRP）、踝臂脉搏波传导速度（baPWV）、颈动脉内膜中层厚度（IMT）及尿微量白蛋白/肌酐（UACR）的检测，baPWV、IMT和UACR分别作为反映动脉硬化和早期肾损害的指标。 结果 与N组比较，H组的BMI（P<0.01）、高血压家族史（P<0.05）、吸烟史（P<0.05）、LDL-C（P<0.01）、hs-CRP（P<0.05）、baPWV（P<0.01）、IMT（P<0.05）与UACR（P<0.05）均显著升高；与N组比较，H组静息SBP升高（P<0.05），次极量运动时SBP、次极量运动时PP、运动后6 min SBP、运动后6 min PP均升高（均P<0.01）；二元Logistic回归结果显示，静息SBP（P<0.05）、吸烟史（P<0.05）、BMI（P<0.01）、hs-CRP（P<0.05）与baPWV（P<0.01）共5个指标与发生运动性高血压之间存在显著正相关关系，而且是影响发生运动性高血压的独立危险因素。次极量运动时SBP与LDL-C（r=0.343，P<0.01）、hs-CRP（r=0.285，P<0.01）、BMI（r=0.294，P<0.01）与baPWV（r=0.371，P<0.01）均呈正相关关系。 结论 在原发性高血压患者中，运动性高血压患者较运动血压正常患者的动脉硬化及早期肾损害更显著，应尽早发现运动性高血压并进行积极干预。 Abstract:AIM To investigate the relationship between exercise hypertension and arteriosclerosis and early renal damage in patients with essential hypertension. METHODS A total of 105 patients with essential hypertension were enrolled in the study. According to Bruce’s protocol, the submaximal running table exercise load test was performed and according to their systolic blood pressure (SBP) at submaximal exercise, the patients were divided into exercise hypertension group (SBP during subextreme exercise≥200 mmHg, H group) and the normalexercise blood pressure group (SBP during subextreme exercise<200 mmHg, N group). Blood lipids, kidney function, fasting blood glucose, high-sensitivity C-reactive protein (hs-CRP), brachial-ankle pulse wave velocity (baPWV), intima-media thickness (IMT), urinary albumin-creatinin ration (UACR), baPWV and UACR were detected in all the patients, which served as indicators of arteriosclerosis and early renal damage. RESULTS Compared with group n, BMI (P<0.01), family history of hypertension (P<0.05), smoking history (P<0.05), LDL-C (P<0.01), hs CRP (P<0.05), baPWV (P<0.01), IMT (P<0.05) and UACR (P<0.05) in group H were significantly increased; Compared with group n, resting SBP in group H increased (P<0.05), SBP during submaximal exercise, PP during submaximal exercise, SBP 6 min after exercise and PP 6 min after exercise increased (all P<0.01); The results of binary logistic regression showed that there was a significant positive correlation between resting SBP (P<0.05), smoking history (P<0.05), BMI (P<0.01), hs CRP (P<0.05) and baPWV (P<0.01), and it was an independent risk factor affecting the occurrence of exercise-induced hypertension. SBP was positively correlated with LDL-C (r=0.343, P<0.01), hs CRP (r=0.285, P<0.01), BMI (r=0.294, P<0.01) and baPWV (r=0.371, P<0.01). CONCLUSION Among patients with essential hypertension, patients with exercise hypertension have more significant arteriosclerosis and early renal damage than patients with normal exercise hypertension. Exercise hypertension should be found as soon as possible and actively intervened. -
Key words:
- essential hypertension /
- exercise hypertension /
- arteriosclerosis /
- early renal damage
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表 1 两组基线资料比较
指标 N组 H组 （n=59） （n=46） 男性 46（78） 37（80） 年龄（岁） 51±7 52±6 BMI（kg/m2） 26.1±2.4 27.8±2.4 b 高血压家族史 15（25） 21（45.7） a 吸烟史 17（29） 22（48） a Fbg（mmol/L） 5.7±1.1 5.7±1.2 TC（mmol/L） 5.0±0.7 5.0±0.7 TG（mmol/L） 2.0±0.9 2.2±1.0 HDL-C（mmol/L） 1.2±0.2 1.2±0.2 BUN（mmol/L） 4.8±0.9 4.7±1.3 SCr（μmol/L） 74±16 79±14 LDL-C（mmol/L） 3.0±0.5 3.2±0.5 b hs-CRP（mg/L） 6.8±2.6 7.9±2.4 a baPWV（m/s） 14.4±1.4 15.4±1.6 b IMT（mm） 1.0±0.3 1.1±0.3 a UACR（mg/mmol） 2.7±0.5 3.0±1.0 a 表中计数资料均为[例数（%）], 与N组比较，aP<0.05，bP<0.01 
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表 2 两组间运动试验血压与观察指标的比较
（ $\bar x $ ±s）状态 指标 N组 H组 （n=59） （n=46） 静息 SBP（mmHg） 138±8 142±8 a DBP（mmHg） 90±6 90±5 PP（mmHg） 48±13 51±10 次极量运动时 SBP（mmHg） 186±9 208±6 b DBP（mmHg） 85±5 85±5 PP（mmHg） 101±11 123±9 b 运动后6 min SBP（mmHg） 149±9 163±9 b DBP（mmHg） 93±5 94±5 PP（mmHg） 55±11 70±9 b 与N组比较，aP<0.05，bP<0.01
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表 3 是否发生EH的二元Logistic回归分析
项目 β SE Wald OR 95%CI 下限 上限 静息SBP 0.101 0.045 5.105 1.106 1.013 1.207 吸烟史 1.209 0.583 4.299 3.350 1.068 10.504 BMI 0.400 0.131 9.292 1.492 1.154 1.929 hs-CRP 0.268 0.121 4.924 1.307 1.032 1.655 baPWV 0.584 0.220 7.025 1.794 1.164 2.763
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表 4 次极量运动时SBP与LDL-C、hs-CRP、BMI、baPWV的相关性分析
指标 次极量运动时SBP r P LDL-C 0.343 <0.01 hs-CRP 0.285 <0.01 BMI 0.294 <0.01 baPWV 0.371 <0.01
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[1] GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disabilityfor 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017[J]. Lancet, 2018, 392(10159): 1789 – 1858. doi: 10.1016/S0140-6736(18)32279-7 [2] Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries[J]. Circulation, 2016, 134(6): 441 – 450. doi: 10.1161/CIRCULATIONAHA.115.018912 [3] Zhang DY, Cheng YB, Guo QH, et al. Subtypes of masked hypertension and target organ damage in untreated outpatients[J]. Blood Press, 2020, 29(5): 299 – 307. doi: 10.1080/08037051.2020.1763159 [4] Ito K, Iwane M, Miyai N, et al. Exaggerated exercise blood pressure response in middle-aged men as a predictor of future blood pressure: a 10-year follow-up[J]. Clin Exp Hypertens, 2016, 38(8): 696 – 700. doi: 10.1080/10641963.2016.1200597 [5] 宋 艾, 秦明照. 6种运动性高血压诊断标准在中国人群中的适用性分析[J]. 中国医药导刊, 2009, 11(4): 537 – 539. doi: 10.3969/j.issn.1009-0959.2009.04.006 [6] Côté CE, Rhéaume C, Poirier P, et al. Deteriorated cardiometabolic risk profile in individuals with excessive blood pressure response to submaximal exercise[J]. Am J Hypertens, 2019, 32(10): 945 – 952. doi: 10.1093/ajh/hpz087 [7] Tsioufis C, Dimitriadis K, Thomopoulos C, et al. Exercise blood pressure response, albuminuria, and arterial stiffness in hypertension[J]. Am J Med, 2008, 121(10): 894 – 902. doi: 10.1016/j.amjmed.2008.05.035 [8] Mert KU, Şener E, Yılmaz AS, et al. The association of exaggerated hypertensive response to exercise and beta-blockers use in hypertensives[J]. Clin Exp Hypertens, 2020, 42(8): 707 – 713. doi: 10.1080/10641963.2020.1779284 [9] Shim CY, Ha JW, Park S, et al. Exaggerated blood pressure response to exercise is associated with augmented rise of AngiotensinⅡduring exercise[J]. J Am Col Cardiol, 2008, 52(4): 287 – 292. doi: 10.1016/j.jacc.2008.03.052 [10] Thanassoulis G, Lyass A, Benjamin EJ, et al. Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study[J]. Circulation, 2012, 125(23): 2836 – 2843. doi: 10.1161/CIRCULATIONAHA.111.063933 [11] Hayaishi-Okano R, Yamasaki Y, Katakami N, et al. Elevated C-reactive protein associates with early-stage carotid atherosclerosis in young subjects with type 1 diabetes[J]. Diabetes Care, 2002, 25(8): 1432 – 1438. doi: 10.2337/diacare.25.8.1432 [12] Kilicaslan B, Eren NK, Nazlı C. Evaluation of aortic elastic properties in patients with exaggerated systolic blood pressure response to exercise testing[J]. Clin Exp Hypertens, 2015, 37(2): 97 – 101. doi: 10.3109/10641963.2014.913603 [13] 刘永岭, 柴春英. 利用血管回声跟踪技术对年轻吸烟人群的动脉弹性研究[J]. 医学理论与实践, 2012, 25(10): 1217 – 1218. doi: 10.3969/j.issn.1001-7585.2012.10.050 [14] 曹悦鞍, 彭朝胜, 何继东, 等. 肥胖伴隐性高血压患者动态动脉硬化指数分析[J]. 心血管康复医学杂志, 2011, 20(5): 442 – 444. doi: 10.3969/j.issn.1008-0074.2011.05.15 [15] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension[J]. J Hypertens, 2018, 36(10): 1953 – 2041. doi: 10.1097/HJH.0000000000001940 [16] David M, Malti O, AlGhatrif M, et al. Pulse wave velocity testing in the baltimore longitudinal study of aging[J]. J Vis Exp, 2014, (84): e50817. doi: 10.3791/50817 [17] Ohkuma T, Ninomiya T, Tomiyama H, et al. Brachial-ankle pulse wave velocity and the risk prediction of cardiovascular disease: an individual participant data meta-analysis[J]. Hypertension, 2017, 69(6): 1045 – 1052. doi: 10.1161/HYPERTENSIONAHA.117.09097 [18] Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis[J]. Nature, 2011, 473(7347): 317 – 325. doi: 10.1038/nature10146 [19] Verma B, Katyal D. Carotid intima-media thickness predicted the presence but not the severity or complexity of coronary artery disease in a South Asian population[J]. Clin Investig Arterioscler, 2022, 34(4): 183 – 192. doi: 10.1016/j.arteri.2021.12.001 [20] 汪晓芬, 王晓明, 刘春萍, 等. 高血压患者亚极量运动时血压与踝臂动脉脉搏波传导速度的相关性[J]. 中华高血压杂志, 2016, 24(10): 978 – 981. doi: 10.16439/j.cnki.1673-7245.2016.10.017 [21] 李 智, 孙 伟. 血压变异与运动血压的相关性研究[J]. 中国医药指南, 2018, 16(27): 161 – 162. doi: 10.15912/j.cnki.gocm.2018.27.129 [22] 中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24 – 56. doi: 10.3969/j.issn.1007-5410.2019.01.002 [23] Tanaka F, Komi R, Makita S, et al. Low-grade albuminuria and incidence of cardiovascular disease and all-cause mortality in nondiabetic and normotensive individuals[J]. J Hypertens, 2016, 34(3): 506 – 512. doi: 10.1097/HJH.0000000000000809 [24] 王 雁, 朱利月, 任爱华. 运动高血压患者的动脉弹性和尿微量白蛋白/肌酐值的分析[J]. 中华全科医学, 2015, 13(8): 1241 – 1243. doi: 10.16766/j.cnki.issn.1674-4152.2015.08.029 -
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