老年人夜间血压下降百分比的临床参考值范围和影响因素

The reference range and associated factors of nocturnal reduction rate among the elderly

目的探讨老年人夜间血压下降百分比(NRR)的临床参考值范围及其影响因素。方法对1207名老年人进行问卷调查、体格检查、实验室检查和24h动态血压检测,分别计算夜间平均动脉压下降的百分比(NRRM)、夜间平均收缩压下降的百分比(NRRS)、夜间平均舒张压下降的百分比(NRRD)。使用百分位数法确定378名正常老年人(无高血压病和脑梗死史)NRR的临床参考值范围,运用多元回归分析方法确定影响1207名老年人NRR的因素。结果正常老年人NRRM、NRRS、NRRD的95%临床参考值范围分别为-10.41%～21.02%、-11.14%～20.55%和-10.10%～23.31%。NRRM、NRRS的影响变量均有性别(P<0.05、P<0.01)、年龄(P<0.05、P<0.01)和脑梗死(均P<0.01);NRRD的影响变量有脑梗塞(P<0.05)。结论老年人NRR与性别、年龄和脑梗死等因素有关。在研究老年人血压昼夜变化规律时,可以选择NRRS,为便于实际应用,可将其临床参考值范围定为-10%～20%。

Objective To explore the reference range and its associated factors of the nocturnal reduction rate （NRR）among the elderly. Methods A cress-sectional storey was conducted comprising a sample of 1207 elderly subjects, The questionnaire contained items on physical examination, laboratory measurement and 24h ambulatory blood pressure monitoring. The reference range of NRR on MAP（NRRM）, NRR on SBP（NRRS ）and NRR on DBP（NRRD） were estimated using the percentile method among 378 elderly subjects without essential hypertension or cerebral infarction. Univariate analysis and multivariate regression analysis were applied to dis cover associated factors of NRR among 1207 subjects. Results 95% reference range of NRRM, NRRS and NRRD among the normal elderly were -10.41%-21.02%, -11.14%-20.55% and -10.10%-23.31% respectively. Associated factors of NRRM among the elderly included gender （ P〈0.05 ） ,age （ P〈0.05 ） and cerehral infarction （ P〈 0.01 ）, associated factors of NRRS included gender （ P〈0.01 ） ,age （ P〈0.01 ） and cerebral infarction （ P〈0.01 ）, associated factor of NRRD was cerebral infarction （P〈0.05）. Conclusion Gender, age and cerebral infarction were significantly associated with NRR among the elderly. NRRS should be considered in clinical study at first and the reference range of NRRS can be -10%-20%.