老老年高血压患者动态血压与靶器官损害的相关性

Relationship Between Ambulatory Blood pressure and Target-organ Damage in Very Elderly Hypertension

目的观察研究80以上老老年高血压病患者血压与靶器官损害之间的关系。方法依据WHO/ISH高血压诊断标准和年龄,将296例受试者分为3组,即老年高血压组(Ⅰ组)90例,平均年龄68·7岁;老老年高血压组(Ⅱ组)116例,平均年龄84·1岁;与老老年正常血压组(Ⅲ组)90例,平均年龄84·7岁。所有受试者均测24h动态血压;进行心脏及颈动脉超声检查,计算出左室重量与左室重量指数以及颈动脉管壁内膜情况及有无斑块形成;检测尿肌酐及尿白蛋白。结果老老年高血压患者左心室重量指数分别为:(159·6±44·9、138·2±32·5、138·1±35·1)g/m2,与老老年正常血压者、老年高血压患者比较有显著性差异,P<0·01。老老年高血压患者颈动脉斑块发生率与老老年正常血压者、老年高血压患者比较有显著性差异,分别为:94·0%、76·7%、71·1%,P<0·05。LVM、LVMI与24hSBP、dSBP、nSBP、nDBP、dPP和nPP显著相关。LogACR(尿白蛋白/尿肌酐比值)与动态血压各参数均相关。结论老老年高血压病患者SBP、SBP-L、PP和MAP与靶器官损害有显著相关性。

Objective To study the association between hypertension and target organ damage in very elderly people. Methods Two hundred ninety-six patients with hypertension were categorized as： elderly hypertension group （n=90, mean age 68.7 years）, very elderly hypertension group （n= 116, mean age 84.1 years） and very elderly normotension group （n=90, mean age 84.7 years）. All subjects were underwent echocardiographic measurement of left ventricular mass index （ LVMI）, carotid artery intima medium thickness, laboratory measurements of urinary creatinine and urinary albumin and 24-hour arnbulatory blood pressure monitoring （ABPM）. Results LVMI was significantly greater in very elderly hypertensive subjects, 159.6±44.9 vs 138. 2±32.5 g/m^2 in very elderly normotensive subjects and 138. 1 ±35.1 g/m^2 in elderly hypertensive subjects, P〈0.01. The incidence of carotid artery plaque was： very elderly hypertensive subjects 93.97%; very elderly normotensive subjects （70.7%） and elderly hypertensive subjects （ 71.1 %）, P〈0.05. Urinary ACR was greater in very elderly hypertensive than in very elderlynormotensive subjects （log ACR, 1.22±0.52 vs 0.94±0.24, P〈0.05）. Parameters of ABPM （dSBP, dDBP, dMAP, dPP） was positively associated with IVST, LVM, LVMI and urinary ACR. Conclusion In advanced old age, hypertension is more significantly associated with evidence of target-organ damage.