目的通过对高原地区高血压病住院患者的危险分层等临床特点及其降压疗效进行初步分析,探讨高原地区高血压的治疗方案。方法对2014年1月至2015年6月期间在海拔3658米西藏拉萨三甲医院住院治疗的高血压患者临床特征、危险因素、心血管疾病综合危险分层、降压治疗方案及血压达标率、降压幅度等指标进行回顾性研究。结果原发性高血压患者合并至少1个以上其他危险因素者占87.5%以上,男性患者合并危险因素数显著多于女性(1.90±1.00与1.27±0.91,p<0.05)。心血管综合危险分层高危、中危、低危者分别占91.11%、8.89%和0%,不同性别之间患者高危比例无显著性差异。出院时总体血压达标率为63.9%,其中高危组64.1%、中危组为62.2%,两组血压达标率无显著性差异,但高危组患者使用了更多种类的降压药物(分别为2.02±0.96及1.65±1.03,P<0.05)。3级高血压患者出院时血压达标率显著低于2级和1级高血压患者(分别为38.2%、73.2%和83.6%,p<0.01);从降压治疗方案来看,应用1种降压药者占32.67%、2种降压药者占37.37%,≥3种降压药者占29.95%;单药降压药物者中氨氯地平组与厄贝沙坦组血压达标率分别为76.0%和63.5%,差异没有显著性(P>0.05)。入院时3级高血压患者中比较不同的联合降压方案的降压疗效,与以A+C为基础的联合方案组比较非A+C为基础的方案收缩压下降更为显著(收缩压下降幅度分别为25.71±11.25(%)与31.18±9.47(%),P<0.05);与不含利尿剂组比较含有利尿剂的联合方案的收缩压下降更为显著(收缩压下降幅度分别为22.94±12.40(%)与28.81±11.36(%),P<0.01)。结论高原地区高血压住院患者合并多重心血管危险因素,且高危者比例高。在近期血压达标方面A+C联合方案似乎不具有优势,而联合应用利尿剂可能具有更显著的降压优势。 Objective To analyze the clinical features and the antihypertensive efficacy of hypertensive patients in the plateau in order to discuss the treatment plan of hypertension in the plateau area. Methods The clinical characteristics, risk factors, integrated risk stratification of cardiovascular disease, antihypertensive treatment regimen and blood pressure compliance rate of hospitalized hypertensive patients at Lhasa Third Hospital of Tibet at 3658 m from January 2014 to June 2015 were analyzed retrospectively. Pressure amplitude and other indicators for retrospective study. Results There were more than 87.5% patients with essential hypertension complicated by at least one other risk factors, and the risk factors of males were significantly more than that of females (1.90 ± 1.00 vs 1.27 ± 0.91, p <0.05). The risk of cardiovascular comprehensive risk stratification were 91.11%, 8.89% and 0%, respectively. There was no significant difference in the proportion of high-risk patients among different sexes. At discharge, the overall blood pressure compliance rate was 63.9%, of which 64.1% in high-risk group and 62.2% in moderate-risk group. There was no significant difference in blood pressure compliance rate between the two groups, but more kinds of antihypertensive drugs were used in high-risk group (2.02 ± 0.96 and 1.65 ± 1.03, P <0.05). The compliance rate of blood pressure in patients with grade 3 hypertension at discharge was significantly lower than those of patients with grade 2 and 1 hypertension (38.2%, 73.2% and 83.6% respectively, p <0.01). From the perspective of antihypertensive treatment, 32.67% were pressured medicine, 37.37% were two kinds of antihypertensive drugs, 29.95% were ≥3 kinds of antihypertensive drugs. The standard of blood pressure of amlodipine and irbesartan in single antihypertensive drugs were 76.0% and 63.5%, the difference was not significant (P> 0.05). The antihypertensive efficacy of different combined antihypertensive regimens in patients with grade 3 hypertension at admission was associated with a more pronounced decrease in systolic BP compared with non-A + C-based regimens in combination A + C-based regimens (systolic pressure decrease (25.71 ± 11.25% vs 31.18 ± 9.47%, P <0.05). Compared with the diuretic-free group, the systolic blood pressure decreased more significantly (systolic blood pressure decreased by 22.94% ± 12.40 (%) and 28.81 ± 11.36 (%), P <0.01). Conclusion Inpatients with hypertension in the plateau are associated with multiple cardiovascular risk factors, and the proportion of high-risk patients is high. In the recent blood pressure compliance A + C joint program does not seem to have advantages, and combined diuretics may have more significant advantages in blood pressure.