住院老年高血压患者死亡相关因素的分析

目的：调查和分析1993～2012年19年间住院的老年高血压患者的死亡原因及影响因素，为北京地区老年高血压防治中靶器官的保护和并发症的减少提供重要临床依据。方法：回顾性分析我院1993～2012年19年间住院死亡的2866例1〉60岁老年高血压患者，通过病历采集，收集性别、年龄、并发症及死亡原因等临床资料，按性别、年龄及高血压分期和危险程度将病人分组。采用卡方检验的方法比较各组病人的死亡原因。结果：①按疾病：与死亡相关性最高的疾病为心脏病1294例（45．15％），脑卒中985例（34．37％），肾功能衰竭340例（11．88％），感染性疾病131例（4．58％），恶性肿瘤116例（4．06％），心脏病是导致老年高血压患者死亡的首要原因；②按性别：男性占老年高血压死亡的53．31％，女性占46．69％，差异具有统计学意义（P〈0．01）。而心脏病（男性46．73％比女性43．35％]和脑卒中（男性37．04％比女性31．32％）均占据高血压死亡原因构成比的前两位；③按年龄：90岁以上高血压患者因心脏病（43．02％）、肾功能衰竭（20．54％）和感染（6．59％）死亡的比例低于其他各年龄组。因脑卒中死亡的比率低于60—69岁组（38．71％）和70～79岁组（33．37％）。因恶性肿瘤死亡的老年高血压患者在70～79岁组最高（4．80％）；④按高血压分期和危险程度：I．Ⅱ期高血压患者因心脏病（49．70％）和恶性肿瘤（7．55％）死亡的比例高于Ⅲ期高血压患者（分别为43．78％和2．99％），而Ⅲ期高血压患者因脑卒中（35．84％）和肾功能衰竭（12．79％）死亡的比例高于I．Ⅱ期高血压患者（分别为29．45％和8．76％）。高危组的老年高血压患者因心脏病（38．15％）死亡的比例低于其他三组（低危组51．05％、中危组47．64％和极高危组47．38％），而其因肾功能衰竭（19．54％）死亡的比例则高于其他三组（低危组1．63％、中危组3．07％和极高危组11．69％），但中危组的老年高血压患者因脑卒中死亡的比例最高（42．69％）。结论：男性患者、60～79岁患者在老年高血压的根本死亡原因中所占的比率较高。不同的高血压分期和危险分层对根本死亡原因有不同的影响。

Incidence and risk factors of the causes of death among elderly hypertensive inpatients

Objective： To retrospectively analyze the causes of death in elderly patients with hypertension in a hospital-based population from 1993 to 2012. Methods：During the study period of over 19 years, a total of 2866 cases of death in 25238 hospitalized hypertensive pa- tients with the age of 60 years or older were documented. Age, gender, complications, cause of death and other relevant variables were col- lected. All patients were divided into different subgroups according to gender, age or hypertension stage and risk stratification. The mortality of elderly hypertensive patients was analyzed using chi-square test. Resttlts： （DTarget organ damage （TOD） associated with hypertension was pre- sent in a substantial proportion of elderly patients. The complications related to death were heart disease （45.15 % ）, stroke （34.37 % ）, renal failure （11.88 % ）, infective disease （4.58 % ）, and cancer （4.06 % ）. Q Mortality in male elderly hypertension was higher than in women （53.31% vs 46.69% ）. The percentage of deaths from heart disease and stroke were higher in men than those in women （heart disease： 46. 73% vs 43.35% ; stroke： 37.04% vs 31.32% ）. QAge-specific constituent ratio of cause of death showed that deaths from stroke were sig- nificantly lower in very old patients （ t〉90 years） than in patients with 60~ 79 years of age （ P 〈 0.01）. In addition, deaths from heart dis- ease, renal failure and infection disease were significantly lower in patients with more than 90 years than other patients. Deaths fiom cancer were highest in patients with 70 ~ 79 years of age （ P 〈 0.01）. QWhen compared with patients at stage 1 and 2 hypertension, subjects at stage 3 were more likely to die from stroke （ P 〈 0.01） and renal failure （ P 〈 0.05）, while less likely to die from heart disease and cancer （ P 〈0.01）. Patients in high and very high risk stratification of hypertension, compared with subjects in low and medium risk were likely to die from renal failure （ P 〈 0.01） whereas less likely to die from heart disease （ P 〈0.05） and stroke （ P 〈 0.01）. Conclusion： Prevalence of complication and TOD is high in elderly hypertensive inpatients, especially in deaths. The male patients and 60 ~ 79-year-old patients have a higher percentage of causes of death. The stage and risk stratification of hypertension are associated with constituent ratios of the causes of death.