Cardiovascular And Renal Damage In Hypertensives Complicated With Metabolic Disorders

The incidence rate of hypertension was increased rapidly in the past ten years.At the same time,the incidence rate of metabolic disturbance soared quickly.On the situation that the genetic background did not have much changement,the effect of bad life style had increased the metabolic disturbance and might affect the course of hypertension.We could observe that,in clinical hypertension patiens,they often had many metabolic disturbances. At the same time the metabolic disturbance could aggravate the target organ damage.Many studies had been done to find the trait of target organ damage when hypertension with single metabolic disturbance.Few people studied the contrast trait of target organ damage in hypertension between many different metabolic disturbances.This study aims to investigate the situation of hypertension with metabolic disturbance,to find out the contrast traits of different metabolic disturbance imposing on hypertension and to provide an opportunity to prevent or delay the damage to target organ of hypertension.Subjects and Methods1.Subjects1863 patients aged 26-94 years old(male 885,and female 978) were divided into five groups:isolated hypertension(361 cases),hypertension with abdominal obesity(176 cases), hypertension with dyslipidemia(237 cases),hypertension with type 2 diabetes(187 cases),hypertension with metabolic syndrome(902 cases).2.MethodsAll patients were inquired the duration of hypertension and were observed to survey blood pressure,the height,body weight,waist circumference(WC) and hip circumference(HC),then calculated the body mass index(BMI) and the waist-to-hip ratio(WHR).Venous blood of patients were collected to assay fasting plasma glucose(FPG),fasting insulin(FINS),glycosylated hemoglobin(HbA₁C),fasting total cholesterol(TC), triglyceride(TG),high density lipoprotein cholesterol(HDL-c),low density lipoprotein cholesterol(LDL-c) and creatinine(Cr).Urinary albumin excretion(UAE) and urinary creatinine were detected and creatinine clearance rate by calculation of the computer.Oral glucose tolerance test and insulin releasing test were performed in some patients.Some patients were observed by Color Doppler echocardiography.The intima-media thickness(IMT) were measured.The arteria carotis of patients were observed to find whether it had carotid plaque.At left ventricular diastole period end point,left ventricle inner diameter(LV),left ventricular posterior wall thickness(LVPW) and interventricular septum thickness(IVS) were messured,then calculated left ventricular mass(LVM) and left ventricular mass index(LVMI) according to Dereveux formula.Results1.Of all the patients,isolated hypertension was only 19.4%and 80.6%hypertensives complicated with the metabolic disorder;even 60%patients suffered from metabolic syndrome.Only 8.9%preliminary diagnosis hypertension did not had metabolic disturbance,more than half patients had many metabolic disturbance and achieved the criterion of metaboli syndrome.2.The IMT was significantly thicker in hypertension with diabetes(P＜0.05).The number of carotid artery plaqe in hypertension with diabetes was the most obvious in the five groups.Left ventricular mass(LVM) and left ventricular mass index(LVMI) were significantly higher in hypertension with abdominal obesity and with MS(P＜0.05 or P＜0.01).The MAU of five groups did not had significant diference.3.The positive rate of IMT thickening in hypertension with diabetes was 38.9%and was the highest in five group.The positive rate of carotid artery plaque in hypertension with diabetes was 57.3%and was the most in the five group with significance(P＜0.05 or P＜0.01). The incidence rate of abnormal microalbuminuria(MAU) was significantly higher in hypertension with diabetes(P＜0.05 or P＜0.01).The positive rate of left ventricular hypertrophy(LVH) in hypertension with abdominal obesity was 55.8%and was significantly higher than isolated hypertension,hypertension with dyslipidemia and hypertension with diabetes(P＜0.05 or P＜0.01).The positive rate of LVH in hypertension with MS was similar to hypertension with abdominal obesity,and was significantly higher than that in other group(P＜0.05 or P＜0.01). Conclusions1.Majority of clinical hypertension complicated with the metabolic disturbance.More than half patients had metabolic disturbance and achieved the criterion of metabolic syndrome(MS).This situation was same in the preliminary diagnosis hypertension,more than 90 percent patients complicated with the metabolic disturbance.2.Hypertension with diabetes could aggravate the vascular damage and renal lesion.3.Hypertension with abdominal obesity and metabolic syndrome could aggravate left ventricular hypertrophy.4.We should not only care about blood pressure of patients,but also pay attention to metabolic disturbances which accompany hypertension.