血压控制正常的中老年高血压病病人动态脉压变化及其对靶器官功能的影响

The changes of ambulatory pulse pressure and the target organs damage in the aged hypertensive patients under controled

目的探讨血压控制正常的中老年高血压病病人动态脉压的变化规律及其对靶器官功能的影响。方法血压控制正常的中老年高血压病合并无症状心肌缺血病人95例,根据基础脉压水平,小于或等于40mmHg(1mmHg=0.133kPa)为A组(23例);大于40mmHg但等于或低于60mmHg为B组(25例);大于60mmHg,但等于或低于80mmHg为C组(23例);超过80mmHg为D组(24例)。所有病人血压控制稳定于正常水平后查动态血压和动态心电图。结果24小时脉压曲线面积:A组为(983±95)mmHg·h,B组为(1204±111)mmHg·h,C组为(1456±115)mmHg·h,D组为(1689±126)mmHg·h。心肌缺血总负荷:A组为(94±8)mm·s;B组为(129±12)mm·s,C组为(166±19)mm·s,D组为(198±20)mm·s。24小时脉压曲线面积与缺血总负荷显著正相关(r=0.324,P<0.005)。每分钟尿白蛋白排泄率:A组为(89±11)μg/min,B组为(101±17)μg/min,C组为(132±17)μg/min;D组为(178±19)μg/min,24小时脉压曲线面积与每分钟尿白蛋白排泄率呈显著正相关(r=0.412,P<0.001)。结论血压控制正常的中老年高血压病病人基础脉压能间接反映动态脉压,基础脉压超过60mmHg病人昼夜脉压波动较大,血压控制正常后,脉压增大病人靶器官的损害较重。

Objectives To evaluate the changes of ambulatory pulse pressure and the target organ damage by ambulatory pulse pressure（PP） in the aged hypertensive patients under controled. Methods 95 aged hypertensive patients with silent myocardial ischemia were studied. These patients were divided into group A （PP ≤40 mmHg）, group B（40 mm Hg〈PP≤60 mm Hg）, group C（60 mm Hg〈PP≤80 nun Hg） and group D（PP〉80 mm Hg）,24-hour ambulatory blood pressure and 24-hour ambulatory electrocardiogram were measured at the same time. Results The average levels of 24-hour pulse pressure（24-HPP）, daytime pulse pressure,nighttime pulse pressure, and the total ischemic burden were significantly different among group A, group B, group C and group D. The average levels of 24-HPP and area of 24-HPP curve were significantly related to total ischemic burden （r1 =0.319, P〈0.01 ; r2=0.324 P〈0.005 ） ; Urine microalbumin excretion were significantly different among group A, group B, group C and group D. The average levels of 24-HPP and area of 24-HPP curve were significantly related to urine microalbumin excretion （r1=0.322 ,P〈0.01 ;r2=0.412, 〈0.001 ）. Conclusions Basic pulse pressure can reflect ambulatory pulse pressure in aged hypertensive patients under controled. There is a little undulation of pulse pressure between day and night in aged hypertensive patients （basic pulse pressure ≤ 60 mm Hg）,there is a lot undulation of pulse pressure in aged hypertensive patients（basic pulse pressure〉60 （mm Hg Pulse pressure increase could damage target organs still in patients with essential hypertension after controled.