老年人群24h动态血压监测中清晨高血压与脑血管储备功能相关性

Study on early morning hypertension,cerebrovascular reserve function,and their correlation in 24 h ambulatory blood pressure monitoring in elderly population

目的研究老年人群24 h动态血压监测中清晨高血压与脑血管储备功能(CVR)的相关性。方法回顾性选取2021年1月至12月到济南市妇幼保健院行24 h动态血压监测的300例老年受试者,依据监测结果分为A组、B组和C组。A组158例为清晨血压升高的高血压患者,男88例,女70例,年龄(66.02±4.35)岁;B组74例为清晨血压正常的高血压患者,男41例,女33例,年龄(65.42±4.42)岁;C组68例为血压正常者,男37例,女31例,年龄(65.77±4.38)岁。以两侧大脑中动脉屏气指数均值<0.69%为CVR减低,屏气指数均值≥0.69%为CVR正常,将300例受试者分为CVR降低组(52例)和CVR正常组(248例)。比较A、B、C 3组患者的临床资料,CVR指标;比较CVR降低组、CVR正常组一般资料,行单因素分析、多因素分析和相关性分析。采用F检验、独立样本t检验、χ^(2)检验、logistic回归分析和Pearson相关性分析。结果300例24 h动态血压监测的老年受试者,清晨血压升高的高血压患者158例,占52.67%;清晨血压正常的高血压患者74例,占24.67%;血压正常者68例,占22.67%。3组收缩压(24 h均值、日间均值、夜间均值)、晨峰指数:A组>B组>C组(均P<0.05);舒张压(24 h均值、日间均值、夜间均值):A组>B组、C组(均P<0.05),B组、C组舒张压比较,差异均无统计学意义(均P>0.05)。CVR:A组[(21.37±7.89)%]<B组[(25.58±8.14)%]<C组[(28.56±8.10)%](均P<0.05);屏气指数:A组[(0.89±0.23)%]<B组[(1.13±0.21)%]、C组[(1.20±0.24)%](均P<0.05),B组、C组屏气指数比较,差异无统计学意义(P>0.05);脉动指数:A组[(1.49±0.36)]>B组[(1.15±0.31)]、C组[(1.06±0.29)](均P<0.05),B组、C组脉动指数比较,差异无统计学意义(P>0.05)。CVR降低组年龄[(73.14±3.21)岁]、清晨收缩压[(132.42±9.64)mmHg](1 mmHg=0.133 kPa)、清晨舒张压[(68.85±6.59)mmHg]均高于CVR正常组[(64.28±4.36)岁、(121.58±7.26)mmHg、(65.36±7.23)mmHg](均P<0.05)。logistic回归分析结果显示:年龄、清晨收缩压、清晨舒张压均为CVR降低的影响因素(均P<0.05)。清晨收缩压与屏气指数呈负相关(P<0.05),与脉动指数呈正相关(P<0.05);清晨舒张压与屏气指数呈负相关(P<0.05),与脉动指数呈正相关(P<0.05)。结论老年人群24 h动态血压监测中清晨高血压患者占比较大,清晨高血压患者CVR、屏气指数较低,脉动指数较高,清晨收缩压、清晨舒张压均与屏气指数呈负相关,与脉动指数呈正相关。

Objective To investigate the correlation between early morning hypertension and cerebrovascular reserve function(CVR)in elderly population during 24 h ambulatory blood pressure monitoring.Methods A total of 300 elderly subjects who came to Jinan Maternal and Child Health Care Hospital for 24 h ambulatory blood pressure monitoring from January to December 2021 were retrospectively selected and were divided into group A,group B,and group C according to the monitoring results.There were 158 hypertensive patients with elevated blood pressure in the morning in group A,88 males and 70 females,aged(66.02±4.35)years.There were 74 hypertensive patients with normal blood pressure in the morning in group B,including 41 males and 33 females,aged(65.42±4.42)years.There were 68 patients with normal blood pressure in group C,including 37 males and 31 females,aged(65.77±4.38)years.With the mean of breath holding index of bilateral middle cerebral artery<0.69%as reduced CVR,and the mean of breath holding index≥0.69%as normal CVR,300 subjects were divided into a CVR reduced group(52 cases)and a CVR normal group(248 cases).The clinical data and CVR indexes among group A,B,and C were compared,the general data of the CVR reduced group and the CVR normal group were compared,and unifactor analysis,multi-factor analysis,and correlation analysis were performed.F test,independent sample t test,χ^(2) test,logistic regression analysis,and Pearson correlation analysis were used.Results Among the 300 elderly subjects monitored for 24 h ambulatory blood pressure,there were 158(52.67%)hypertensive patients with elevated blood pressure in the morning,74(24.67%)hypertensive patients with normal blood pressure in the morning,and 68(22.67%)patients with normal blood pressure.The systolic blood pressure(24 h mean,daytime mean,and nighttime mean)and morning peak index of the 3 groups were as follow:group A>group B>group C(all P<0.05).The diastolic blood pressure(24 h mean,daytime mean,and nighttime mean)of the 3 groups were as follow:group A>group B and group C(all P<0.05),there were no statistically significant differences between group B and group C(all P>0.05).CVR:group A[(21.37±7.89)%]<group B[(25.58±8.14)%]<group C[(28.56±8.10)%](all P<0.05).Breath holding index:group A[(0.89±0.23)%]<group B[(1.13±0.21)%]and group C[(1.20±0.24)%](both P<0.05);there was no statistically significant difference in the breath holding index between group B and group C(P>0.05).Pulsation index:group A[(1.49±0.36)]>group B[(1.15±0.31)]and group C[(1.06±0.29)](both P<0.05);there was no statistically significant difference in the pulsation index between group B and group C(P>0.05).In the CVR reduced group,the age[(73.14±3.21)years old],morning systolic blood pressure[(132.42±9.64)mmHg(1 mmHg=0.133 kPa)],and morning diastolic blood pressure[(68.85±6.59)mmHg]were higher than those in the CVR normal group[(64.28±4.36)years old,(121.58±7.26)mmHg,and(65.36±7.23)mmHg](all P<0.05).Logistic regression analysis showed that age,morning systolic blood pressure,and morning diastolic blood pressure were all influencing factors for the decrease of CVR(all P<0.05).The morning systolic blood pressure was negatively correlated with breath holding index(P<0.05),and positively correlated with pulsation index(P<0.05).The morning diastolic blood pressure was negatively correlated with breath holding index(P<0.05),and positively correlated with pulsation index(P<0.05).Conclusions In 24 h ambulatory blood pressure monitoring in elderly population,early morning hypertension patients had lower CVR and breath-holding index and higher pulsation index.Early morning systolic blood pressure and early morning diastolic blood pressure are negatively correlated with breath-holding index and positively correlated with pulsation index.