动态脉压与老年高血压合并冠心病及颈动脉硬化的关系

Relationship of ambulatory pulse pressure with coronary heart disease and carotid atherosclerosis in elderly patients with essential hypertension

目的研究老年高血压患者动态脉压(PP)与冠心病并发症及颈动脉粥样硬化的关系,为临床有针对性的干预PP、预防高血压并发症提供理论基础。方法对老年高血压及老年高血压合并冠心病的动态PP进行比较,同时对老年高血压颈动脉内膜中层厚度(IMT)增厚组与正常组的动态PP进行比较。结果(1)与单纯高血压组比较,高血压合并冠心病组的24h动态脉压(24hAPP)、白昼脉压(dPP)、夜间脉压(nPP)水平显著增大,24h平均收缩压(24hASBP)、夜间平均收缩压(nSBP)水平显著升高,24h平均舒张压(24hADBP)、白昼平均舒张压(dDBP)、夜间平均舒张压(nDBP)水平显著下降,而2组间dSBP比较无统计学意义;(2)老年高血压患者IMT增厚组的24hAPP、dPP和nPP水平均显著高于IMT正常组;(3)与动态PP<60mmHg者比较,动态PP≥60mmHg的高血压患者冠心病发生率显著升高;(4)与动态PP<60mmHg者比较,动态PP≥60mmHg的单纯高血压患者的IMT显著增厚。结论动态PP增大是老年高血压患者颈动脉粥样硬化及未来发生冠心病的重要危险因素。

Objective To investigate the relationship of ambulatory pulse pressure （PP） with coronary heart disease （CHD） and carotid atherosclerosis in elderly hypertensive patients. Methods 24 h ambulatory blood pressure was measured in a total of 312 elderly patients with essential hypertension （EH）, including 153 patients with simple EH and 159 subjects with EH complicated with CHD. Ambulatory PP, systolic blood pressure （SBP） and diastolic blood pressure （DBP） were compared between two groups, The hypertensive patients without CHD were further divided into 2 subgroups according to carotid artery intima-media thickness （ IMT, 〈 0, 9 mm into normal IMT group, ≥0.9 mm into thick IMT group） and ambulatory PP was compared. Results （ 1 ） The group of EH complicated with CHD had higher 24h ambulatory PP, diurnal PP and nocturnal PP（ P 〈 0, 01 ）, higher 24h ambulatory SBP（ P 〈 0. 05 ） and noctural SBP（ P 〈 0. 01 ）, lower 24 h ambulatory DBP, diurnal DBP and nocturnal DBP（ P 〈 0. 01 ） than the group of EH without CHD ; （ 2 ） 24 h ambulatory PP, diurnal PP and nocturnal PP of thick IMT group were significantly higher than those of normal IMT group（P 〈 0. 01 ） ; （3） The presence of CHD was significantly higher in hypertensive patients with ambulatory PP~〉60 mmHg than that in those with ambulatory PP 〈60 mmHg （58.51% vs. 39.52%, P 〈0. 01 ） ; （4） Carotid IMT was significantly high- er in simple hypertensive patients with ambulatory PP I〉60 mmHg compared with those with ambulatory PP 〈 60mmHg（ P 〈 0. 01 ）. Conclusions Augmentation of ambulatory PP was one of the important risk factors responsible for development of early atherosclerosis and subsequent occurrence of CHD in elderly hypertensive patients.