老年原发性高血压患者血压晨峰的分析与干预研究

Clinical Significance and Therapy of Morning Blood Pressure Surge in Senile Patients with Primary Hypertension

目的:探讨老年原发性高血压患者血压晨峰与年龄和性别的相关性、晨峰患者心血管事件的风险,以及血压晨峰的治疗方法。方法:采用动态血压监测仪分析220例老年高血压患者的血压,确认晨峰组与非晨峰组,测定QT离散度和LVM I,选择部分患者,观察不同的药物、不同的给药时间对晨峰的治疗效果。结果:①与非晨峰组相比较,晨峰组凌晨收缩压、脉压较高(P<0.001)。凌晨血压增高与年龄相关(P<0.05),与性别无相关(P>0.05)。②与非晨峰组相比,血压晨峰组的QT离散度增大,差别有显著意义(P<0.001)。③血压晨峰组的LVH发生率为57.3%,非晨峰组为43.8%,差别显著(P<0.05)。④睡前服药组凌晨血压下降的程度大于清晨服药组,钙离子拮抗剂优于转换酶抑制剂。结论:①血压晨峰与年龄相关。②血压晨峰使心血管事件的风险增加。③睡前服药对晨峰的治疗效果较好,钙离子拮抗剂优于转换酶抑制剂。

Objective： To investigate the relationship between morning blood pressure surge （ MBPS ） and age, sex in senile patients with primary hypertension. To investigate the cardiovascular risk and the ther- apeutic intervention in those patients who suffer from morning blood pressure surge. Method： The blood pressure of 220 senile patients with primary hypertension was 24 - hour monitored. We measured QTd and LVMI, and analyzed the therapeutic efficacy of MBPS. Result： Morning systolic blood pressure （ SBP ）, pulse pressure （ PP ） in patients with morning blood pressure surge were higher than that in those without morning blood pressure surge （ P 〈0.001 ）. Morning blood pressure surge correlated with age （ P 〈 0.05 ）, uncorrelated with sex （ P 〉 0.05 ）. The QTd extended and the incidence of LVH increased in those patients with morning blood pressure surge. The patients who take medicine before sleeping at night get better effects in morning blood pressure surge control than those who take medicine in morning. CCB was better than ACEI in controlling morning blood pressure surge. Conclusion： Morning blood pressure surge correlated with age. It is an predictor of cardiovascular risk in senile patients with primary hypertension. The patients who take medicine before sleeping at hight get better effects in morning blood pressure surge control than those who take medicine in morning.