高血压伴腔隙性脑梗死患者夜间动态血压的变化

Nocturnal blood pressure variation in hypertensive patients with lacunar infarct

目的 探讨动态血压监测 (ABPM)在防治脑梗死中的作用。方法 采用无创性携带式动态血压检测仪 ,对 5 0例高血压伴有腔隙性脑梗死的患者及 33例不伴有脑梗死的高血压患者 (对照组 )进行动态血压检测 ,并观察其随测血压。结果 腔隙性脑梗死组夜间 (10pm～ 6am)平均收缩压与舒张压显著低于对照组 ,夜间、白昼的收缩压与舒张压比值与对照组比较 ,差异有显著性意义。结论 伴有腔隙性脑梗死的高血压患者机体调节血压昼夜节律变化的机制紊乱 ,较无腔隙性脑梗死的高血压患者严重 ;夜间平均收缩压与舒张压过低可能是部分高血压患者发生腔隙性脑梗死的重要因素之一。

Objective To explore the clinical value of ambulatory blood pressure monitoring(ABPM) in prevention and treatment of cerebral infarction.Methods ABPM was carried out and casual blood pressure(CBP) was examined in 50 hypertensives with lacunar infarct (LI)and 33 hypertensives without lacunar infarct (control group).Blood pressure readings were obtained automatically at 15 minute intervals in the daytime (6:00～ 22:00) and at 30 minute intervals in the nighttime (22:00～6:00).24 hour mean systolic blood pressure (SBP) and diastolic blood pressure (DBP),24hmaxSBP and 24hmaxDBP,24hminSBP and 24hminDBP,mean daytime SBP(dSBP) and DBP(dDBP),mean nighttime SBP(nSBP) and DBP(nDBP),nSBP/dSBP and nDBP/dDBP were calculated for each case.Results There is no significant difference of CBP between two groups,but nSBP and nDBP in patients with lacunar infarction were significantly lower than those in patients without lacunar infarction(P<0.05).The ratios of nSBP/dSBP and nDBP/dDBP in LI were smaller than those in control group respectively.Conclusions The results indicate that an inappropriately low nocturnal blood pressure or an excessive fall in nocturnal blood pressure is associated with lacunar infarct.It is necessary not only to control high blood pressure but also to pay attention to circadian changes of blood pressure during the course of anti-hypertensive treatment.