| Objective:The purpose of this paper is to retrospectively analyze the relevant clinical data of young patients with hypertension,to study the gender differences of hypertension,and to provide clinical reference for the prevention and treatment of young patients with hypertension according to the clinical characteristics of young patients with hypertension.Methods:A total of 201 young patients(aged≤44 years)with hypertension diagnosed in the second Hospital of Jilin University from January 2018 to November 2022 were selected as subjects.The general baseline data,basic etiological composition,risk factors of hypertension,clinical symptoms,laboratory examination,imaging examination,treatment,cardiovascular risk factors related to prognosis,target organ damage and concomitant clinical diseases of these patients were retrospectively analyzed.In addition,85 young patients with hypertension were collected for ambulatory blood pressure monitoring in the same period,and the related parameters of ambulatory blood pressure were analyzed,and the corresponding conclusions were obtained by statistical analysis using SPSS26.0 software.Results:1.General baseline data: among the 201 young patients with hypertension,there were 138 males(68.7%)and 63 females(31.3%),The male-to-female ratio is about 2.22.Basic etiological composition : there were 137 cases of primary hypertension(68.16%)and 64 cases of secondary hypertension(31.84%).According to the proportion of causes,there were 21 cases of primary aldosteronism(10.45%),18 cases of renal parenchyma hypertension(8.96%)and 13 cases of renovascular hypertension(6.47%).There were 4 cases of Cushing syndrome(1.99%),3 cases of obstructive sleep apnea syndrome(1.49%),3 cases of thyroid dysfunction(1.49%)and 2 cases of pheochromocytoma(1.00%).The proportion of renovascular hypertension in the female group was higher than that in the male group,and the proportion of primary aldosteronism in the female group was significantly lower than that in the male group(P < 0.05).3.Risk factors of hypertension : among the 201 young patients with hypertension,the general risk factors were 172 cases of overweight and obesity(85.57%),159 cases of lack of physical activity(79.10%),115 cases of family history of hypertension(57.21%),107 cases of high-fat diet(53.23%),88 cases of high-sodium diet(43.78%),33 cases of excessive drinking(16.42%)and 15 cases of diabetes(7.46%).The BMI of the male group was higher than that of the female group.The proportion of overweight and obesity,high sodium diet,high fat diet,lack of physical activity and excessive drinking in the male group was significantly higher than that in the female group4.Clinical symptoms: 201 young patients with hypertension were mostly asymptomatic,80(39.80%),followed by dizziness in 66(32.84%),headache in 39(19.40%),chest tightness in 25(12.44%),palpitation in 23(11.44%),shortness of breath in 19(9.45%),blurred vision in 10(4.98%),nausea and vomiting in 8(3.98%),and fatigue in 7(3.48%).5.Laboratory examination: the indexes of triglyceride,retinol-binding protein,hypersensitive C-reactive protein,serum creatinine,serum uric acid,blood homocysteine,hemoglobin and hematocrit in male group were higher than those in female group.the indexes of high density lipoprotein cholesterol,apolipoprotein A1 and glomerular filtration rate were significantly lower than those in female group(P <0.05).6.Imaging examination:(1)ECG: 96 patients(47.76%)showed normal ECG,followed by 73 cases of T wave inversion or low flat(36.32%),28 cases of arrhythmia(13.93%),including 12 cases of sinus tachycardia,6 cases of first degree atrioventricular block,5 cases of sinus bradycardia and 5 cases of atrial fibrillation.ST segment decreased in 27 cases(13.43%),left ventricular hypertrophy in 25 cases(12.44%),old myocardial infarction in 9 cases(4.48%),ST segment raised upward in5 cases(2.49%).The proportion of left ventricular hypertrophy in male group was higher than that in female group(15.9% vs 4.8%).The difference was statistically significant.(2)Echocardiography: the values of LA,LVDd,IVST,PWT,AO and LVMI in male group were higher than those in female group,and the difference was statistically significant.(3)Imaging examinations of adrenal CT,renal artery color ultrasound,head CT or MRI,cervical vascular ultrasound,abdominal color ultrasound:the proportion of cerebral infarction and fatty liver in male group was higher than that in female group,while the proportion of renal artery stenosis in male group was lower than that in female group.7.Antihypertensive treatment during hospitalization: the most commonly used antihypertensive drug in young patients with hypertension is calcium channel blocker(64.68%).The other drugs were angiotensin receptor blocker(48.26%),β-blocker(39.30%),diuretic(24.88%),angiotensin receptor enkephalin inhibitor(10.45%),aldosterone receptor antagonist(6.97%),angiotensin converting enzyme inhibitor(6.97%),α β receptor blocker(2.99%).The use of calcium channel blockers,diuretics and angiotensin receptor enkephalin inhibitors in the male group was significantly higher than that in the female group(P < 0.05).8.Treatment of risk factors related to hypertension: among the 201 young patients with hypertension,89(44.28%)were complicated with dyslipidemia,including 70 males and 19 females.58 cases(82.9%)received lipid-lowering treatment in male group and 11 cases(57.9%)in female group.The proportion of lipid-lowering treatment in male group was significantly higher than that in female group(P < 0.05).9.Blood pressure control at discharge: the average systolic blood pressure(SBP)and diastolic blood pressure(DBP)of 201 young patients with hypertension were 135(128,145)mm Hg and 85(78,95)mm Hg,respectively.Blood pressure control was up to standard in 131cases(65.17%)and substandard in 70 cases(34.83%).10.Cardiovascular risk factors related to prognosis: the proportion of grade 3hypertension in the male group was higher than that in the female group,while the proportion of grade 2 hypertension in the male group was lower than that in the female group.The proportion of cardiovascular risk factors such as smoking history,dyslipidemia,family history of premature cardiovascular disease,obesity and hyperhomocysteinemia in male group was significantly higher than that in female group(P < 0.05).11.Target organ damage: the first target organ damage in young patients with hypertension was carotid porridge-like plaque in 69 cases(34.33%),followed by left ventricular hypertrophy in 45 cases(22.39%),decreased glomerular filtration rate or slight increase in serum creatinine in 16 cases(7.96%).Multivariate logistic regression analysis showed that Hcy(OR=1.035,95%CI:1.001-1.070)and RBP(OR=1.039,95CI:1.009-1.071)were independent risk factors for left ventricular hypertrophy in young patients with hypertension.LDL-C(OR=2.225,95%CI:1.226-4.037)and diabetes mellitus(OR=6.296,95%CI:1.508-26.281)are independent risk factors for carotid porridge-like plaque in young patients with hypertension.12.Concomitant clinical diseases: the most common clinical diseases in 201 young patients with hypertension were peripheral artery stenosis / occlusion,78 cases(38.81%).The other diseases were ischemic stroke in 36 cases(17.9%),diabetes in 22cases(10.95%),impaired renal function in 19 cases(9.45%),myocardial infarction in12 cases(5.97%)and angina pectoris in 9 cases(4.48%).There were 5 cases of chronic heart failure(2.49%)and 4 cases of cerebral hemorrhage(1.99%).Among them,the proportion of ischemic stroke and renal function impairment in male group was higher than that in female group,and the difference was statistically significant(P< 0.05).13.Parameters related to ambulatory blood pressure: before treatment,the circadian rhythm of blood pressure in 85 young patients with hypertension was mainly non-dipper,44 cases(51.76%).The rest were as follows: inverse dipper rhythm in 23 cases(27.06%),dipper rhythm in 16 cases(18.82%),super dipper rhythm in 2 cases(2.35%).The most common type of blood pressure was persistent hypertension in 47 cases(55.29%),followed by masked hypertension in 21 cases(24.71%)and white coat hypertension in 17 cases(20.00%).Conclusions:1.In young patients with hypertension,there are more males than females.Primary aldosteronism is the most common secondary cause in young males,and renovascular hypertension is more common in young females.2.Young male patients with hypertension are often associated with risk factors such as overweight and obesity,high sodium,high fat diet,lack of physical activity,excessive drinking and other clinical diseases such as ischemic stroke and impaired renal function.3.Blood homocysteine and Retinol-binding protein are independent risk factors for left ventricular hypertrophy in young patients with hypertension,while LDL-C and diabetes are independent risk factors for carotid porridge-like plaque in young patients with hypertension.4.The circadian rhythm of blood pressure in young patients with hypertension was mainly non-dipper rhythm,and the blood pressure phenotype was persistent hypertension,and there was no gender difference. |
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