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背景:决定是否给予降压治疗时,不仅要根据其血压水平,还要根据其危险分层,目前国内已开展了对原发性高血压辨证分型与高血压分级、危险分层关系的探讨。目的:将传统中医辨证方法同现代医学进展相结合,探讨原发性高血压辨证分型与高血压分级、危险分层的关系。设计:叙述性观察。单位:上海市静安区中心医院中医科及上海大华医院。对象:上海市静安区中心医院中医科收治的不同性别、年龄的原发性高血压住院患者64例。方法:原发性高血压辨证分为风阳上扰、痰浊上蒙、气血亏虚、肝肾阴虚证4型。基于西医辨病与中医辨证相结合,探讨原发性高血压辨证分型与高血压分级、危险分层的关系。主要观察指标:原发性高血压辨证分型与患者年龄、病程、血压、血压分级、危险分层的关系。结果:64例患者均进入结果分析。①辨证分型与年龄、病程、血压高低的关系:风阳上扰组患者年龄较痰浊上蒙及肝肾阴虚组轻犤(59.0±10.9),(72.7±9.1),(71.6±10.1)年,P<0.01犦;肝肾阴虚组患者病程较风阳上扰组及痰浊上蒙组长犤(160.5±143.5),(64.8±70.8),(80.6±108.7)个月,P<0.05犦;不同证型原发性高血压患者收缩压差异不显著,而舒张压风阳上扰组较其他3组高犤(99±8),(92±9),(89±11),(89±12)mmHg,P<0.05犦。②辨证分型与血压分级、危险分层的关系:不同证型患者血压分级差异不显著;风阳上扰组患者危险分层低于痰浊上蒙和肝肾阴虚组(极高危、高危、中危及低危分别有3,7,5,3;15,1,1,1;16,1,2,1例,P<0.05)。结论:中医证型的不同可能反映出高血压分级和分层的高低差异,可为确定治疗方针提供依据。
Background: To decide whether to give antihypertensive treatment is not only based on its blood pressure level, but also according to its risk stratification. At present, China has conducted a study on the relationship between syndrome differentiation of essential hypertension and classification of hypertension and risk stratification . OBJECTIVE: To combine the traditional Chinese medicine syndrome differentiation method with the progress of modern medicine to explore the relationship between syndrome differentiation of hypertension and classification of hypertension and risk stratification. Design: Narrative observation. Unit: Shanghai Jing’an District Central Hospital and Shanghai Dahua Hospital. PARTICIPANTS: 64 cases of primary hypertension inpatients with different gender and age treated by Department of Traditional Chinese Medicine, Jing’an District Central Hospital, Shanghai. Methods: Essential Hypertension syndrome differentiation into the wind on the disturbance, phlegm on Mongolia, blood deficiency, liver and kidney yin deficiency type 4. Based on the combination of traditional Chinese medicine and TCM syndrome differentiation, we explored the relationship between syndrome differentiation of hypertension and classification of hypertension and risk stratification. MAIN OUTCOME MEASURES: The relationship between syndrome differentiation of primary hypertension and patient’s age, course of disease, blood pressure, blood pressure classification and risk stratification. Results: All 64 patients entered the result analysis. (1) The relationship between syndrome differentiation and age, course of disease and blood pressure: The age of Fengyang on disturbance group was (59.0 ± 10.9), (72.7 ± 9.1) and (71.6 ± 10.1) ), P <0.01 犦. The duration of liver-kidney yin deficiency group was longer than that of the wind-yang upset group and phlegm-turbid upper Mongolian group (.5 160.5 ± 143.5), (64.8 ± 70.8), (80.6 ± 108.7) months, P <0.05 犦. There was no significant difference in systolic blood pressure among patients with different syndromes of essential hypertension, while the diastolic blood pressure was significantly higher than those of the other three groups (99 ± 8, (92 ± 9), (89 ± 11) , (89 ± 12) mmHg, P <0.05 犦. (2) The relationship between syndrome differentiation and blood pressure classification and risk stratification: There was no significant difference in blood pressure classification among different syndromes; the risk stratification was lower in patients on Feng Yang Shang disturbance group than in phlegm-turbid upper kidney and liver-kidney yin deficiency group , Medium and low risk were 3,7,5,3; 15,1,1,1; 16,1,2,1 cases, P <0.05). Conclusion: The different TCM syndromes may reflect the difference of hypertension grade and stratification, which may provide evidence for the determination of treatment guidelines.