控制血糖对老年原发性高血压合并2型糖尿病患者血压变异性的影响

Effects of glucose control on blood pressure variability in elderly hypertensive patients with type 2 diabetes mellitus

目的探讨控制血糖对老年原发性高血压(EH)合并2型糖尿病(T2DM)患者血压变异性(BPV)的影响。方法临床确诊60例EH合并T2DM老年患者,糖化血红蛋白(HbA1c)含量检测均>8.0 mmol/L,在给予原有抗高血压药物治疗同时,行控制血糖治疗3月后复查HbA1c,根据检测指标分为2组:A组为HbA1c达标组(HbA1c<7.0 mmol/L),B组为HbA1c未达标组(HbA1c>7.0 mmol/L)。控制血糖治疗前后分别进行动态血压测定,比较患者BPV的变化。以各时间段血压的标准差(SD)作为血压变异的指标:24 h收缩压变异(24hSSD)和24 h舒张压变异(24hDSD)、白昼收缩压变异(dSSD)和舒张压变异(dDSD)、夜间收缩压变异(nSSD)和舒张压变异(nDSD)。结果 (1)EH合并T2DM患者,行控制血糖治疗HbA1c达标组治疗后与治疗前比较,24hDSD、dDSD、nDSD无显著差异(P>0.05),24hSSD、dSSD、nSSD有显著差异(P<0.05)。(2)EH合并T2DM患者,行控制血糖治疗HbA1c未达标组治疗后与治疗前比较,患者的24hSSD、24hDSD、dSSD、dDSD、nDSD均无显著差异(P>0.05),nSSD有显著差异(P<0.05)。(3)EH合并T2DM患者24hSSD、24hDSD变化与HbA1c含量呈正相关(r=0.531、0.667,P<0.05)。结论在原有抗高血压药物治疗同时,控制血糖治疗可显著改善EH合并T2DM患者的BPV,改善其心血管系统血流动力学,从而减少心血管病并发症。

Objective To study the effects of glucose control on blood pressure variability（BPV） in elderly essential hypertensive（EH） patients with type 2 diabetes mellitus（T2DM）.Methods Sixty elderly patients with EH combined with T2DM whose HbA1c were more than 8.0 mmol/L were enrolled in this study.The patients received 3 months＇ glucose control and routine antihypertension treatment,and then underwent HbA1c measurement.According to the level of HbA1c,the patients were divided into group A（HbA1c 7.0 mmol/L） and group B（HbA1c7.0 mmol/L）.All patients received the 24-hour blood pressure monitoring before and after treatment.The blood pressure variability（BPV） was measured and analyzed.The parameters were as follows： 24hSSD,24hDSD,dSSD,dDSD,nSSD and nDSD.Results ① In group A,after teratment,the variations of 24hDSD,dDSD and nDSD were not significant（P〈0.05）,while the variations of 24hSSD,dSSD and nSSD were significant（P〈0.05）.② In group B,after teratment,the variations of nSSD were significant（P〈0.05）,while the variations of 24hSSD,24hDSD,dSSD,dDSD and nDSD were not significant（P〈0.05）.③ The variations of 24hSSD,24hDSD were significantly positively correlated with HbA1c（r=0.531,0.667,P〈0.05）.Conclusions During the routine antihypertensive treatment,glucose control can significantly modify the BPV in elderly patients with EH combined with T2DM.