美国心脏协会(AHA)于2017年发布了高血压诊断和治疗指南。根据这些指南,成人先天性心脏病(ACHD)的高血压患病率尚未得到表征。我们试图评估患病率,影响,和提供者对目前指南下高血压的反应。数据是从10年的常规诊所就诊记录中回顾性获得的。潜在的高血压相关不良结局,包括卒中,心肌梗塞,主动脉瘤的外科干预,主动脉夹层,心房颤动或扑动,记录心脏移植和死亡。符合纳入标准的1070例患者的平均年龄为30.8±10.0岁。2017年指南下的高血压患病率为46.6%。多变量建模确定紫癜,男性,年龄较大,超重/肥胖是高血压的独立危险因素。ACHD患者高血压的指导管理在ACHD和成人心脏病学诊所中的发生率高于儿科心脏病学诊所(44.1%和45.1%vs.24.0%,p分别<0.01)。217例(20%)患者报告了不良结局,其中最普遍的是心房颤动或扑动(11%).针对年龄较大的任何不良结果进行多变量建模,高血压,紫癜,更复杂的ACHD,肥胖是危险因素。动脉粥样硬化性心血管疾病的可调节危险因素在ACHD人群中很常见,并且经常未得到解决。
Guidelines for the diagnosis and treatment of hypertension were published by the American Heart Association (AHA) in 2017. The prevalence of hypertension in adults with congenital heart disease (ACHD) under these guidelines has yet to be characterized. We sought to assess the prevalence, impact, and provider response to hypertension under current guidelines. Data were obtained retrospectively from records of routine clinic visits over a 10 year period. Potential hypertension-related adverse outcomes including stroke, myocardial infarction, surgical intervention for aortic aneurysm, aortic dissection, atrial fibrillation or flutter, cardiac transplantation and death were recorded. The 1070 patients who met inclusion criteria had a mean age of 30.8 ± 10.0 years. The prevalence of hypertension under the 2017
guidelines was 46.6%. Multivariate modeling identified
cyanosis, male gender, older age, and overweight/obesity as independent risk factors for hypertension.
Guideline-directed management of hypertension in ACHD patients occurred more frequently in ACHD and adult cardiology clinics than in pediatric cardiology clinics (44.1% and 45.1% vs. 24.0%, p < 0.01, respectively). Adverse outcomes were reported in 217 (20%) patients, the most prevalent of which was atrial fibrillation or flutter (11%). Multivariable modelling for any adverse outcome identified older age, hypertension,
cyanosis, greater complexity ACHD, and obesity as risk factors. Modifiable risk factors for atherosclerotic cardiovascular disease are common and often under addressed in the ACHD population.