70岁以上老年高血压合并腔隙性脑梗死患者动态血压特征

Charactor of ambulatory blood pressure monitoring in elderly primary hypertensives with lacunar infarct

目的探讨70岁以上老年高血压合并腔隙性脑梗死患者的动态血压特征。方法所有患者均行头颅磁共振成像(MRI)检查;采用无创性携带式动态血压监测仪,对30例高血压伴有腔隙性脑梗死的患者及28例不伴有腔隙性脑梗死的高血压患者(对照组)进行动态血压监测。结果腔隙性脑梗死组24小时收缩压、夜间收缩压、24小时脉压、日间脉压及夜间脉压显著高于对照组,分别为(124.2±10.1)mm Hg vs(117.3±10.9)mm Hg,(125.2±11.5)mm Hg vs(114.4±15.4)mm Hg,(50.2±7.0)mm Hg vs(44.9±7.7)mm Hg,(50.2±7.2)mm Hg vs(46.0±7.1)mm Hg,(51.4±7.9)mm Hg vs(43.8±9.6)mm Hg(均P<0.05);腔隙性脑梗死组非勺型血压的发生率(93.3%)高于对照组(64.3%),差异有统计学意义。结论收缩压尤其是夜间收缩压升高,脉压差增大,有可能是老年高血压患者发生腔隙性脑梗死的重要危险因素;合并腔隙性脑梗死的老年原发性高血压患者出现更高比例的血压调节机制紊乱。

Objective To explore the charactor of ambulatory blood pressure monitoring（ABPM） in elderly hypertensives with lacunar infarct. Methods Fifty-eight patients underwent the examination of brain MRI;ABPM was carried out in 30 hypertensives with lacunar infarct and 28 hypertensives without lacunar infarct（control group）. Results 24 hour mean systolic blood pressure（24 h SBP） ,mean nighttime SBP（nSBP） ,24 h pulse pressure（PP） ,day pulse pressure（dPP） and night pulse pressure（nPP） in patients with lacunar infarct werk significantly higher than those in patients without lacunar infarction（124.2± 10.1） mm Hg vs （117.3±10.9） mm Hg; （125.2± 11.5） mm Hg vs （114.4±15.4） mm Hg;（50.2±7.0） mm Hg vs （44.9±7.7） mm Hg vs （50. 2 ± 7. 2） mm Hg vs （46.0±7.1） mm Hg; （51.4± 7.9） mm Hg vs （43.8 ± 9.6） mm Hg （all P 〈 0.05）. The incidence of non-dipper change in the hypertensives with lacunar infarct（93.3%） was obviously increased than that in the control group（64.3%）. Conclusion The mean nighttime SBP（nSBP） and pulse pressure（PP） increase are important risk factors in the onset of lacunar infarct in hypertensives; Disorder of circadian rhythm is significantly higher in hypertensives with lacunar infarct, than that in hypertensives without lacunar infarct.