70岁以上老年糖尿病对高血压患者动态血压及血压变异的影响

70 years old Effects of type 2 diabetes mellitus on ambulatory blood pressure and blood pressure variability in essential hypertensive patients

目的探讨70岁以上老年2型糖尿病(T2DM)对原发性高血压(EH)患者的动态血压(ABP)及血压变异(BPV)的影响。方法选取74例单纯EH及74例合并T2DM的EH患者,行24小时ABP监测,对2组患者的ABP及BPV进行对比分析。结果2组患者ABP参数比较,合并T2DM的EH患者日间平均收缩压(dmSBP)及夜间平均收缩压(nmSBP)高于单纯EH患者(P<0.05或0.01);脉压分析发现,合并T2DM的EH患者日间脉压(dmPP)、夜间脉压(nmPP)及24小时平均脉压差(24h-mPP)均大于单纯EH患者(P<0.05或0.01);2组BPV参数比较,合并T2DM的EH患者日间收缩压标准差(dSBPSD)及日间收缩压标准差变异系数(dSBPCV)、夜间收缩压标准差(nSBPSD)及夜间收缩压标准差变异系数(nSBPCV)、24小时收缩压标准差(24h-SBPSD)均显著高于单纯EH患者(P<0.05或0.01)。结论T2DM加重EH患者心血管系统的结构与功能异常,引起ABP及BPV增大,改善其体内糖代谢状况,将有助于改善其心血管系统血流动力学,从而减少心血管并发症。

Objective To explore the 70 years old effects of type 2 diabetes meltitus （T2DM） on ambulatory blood pressure （ ABP ） and blood pressure variability （ BPV ） in essential hypertensive （ EH ） patients. Methods Twenty - four - hour recordings of ambulatory biood pressure were performed in 74 EH patients and 74 EH patients with T2DM, and comparative analysis of ABP and BPV was made between the two groups. Results Mean daytime systolic blood pressure （ dmSBP ） and night systolic blood pressure（ nmSBP） （ P 〈 0. 05 and 0. 01 ） , Mean daytime pulse pressure（ dmPP） and night pulse pressure（ nmPP） and 24h - pulse pressure（ 24h - mPP） （ P 〈 0.05 and 0.01 ） , daytime SBP standard deviation （ dSBPSD ） and its coefficient of variance （ dSB- PCV ） and night SBP standard deviation（ nSBPSD ） and its coefficient of variance （nSBPCV ） and 24h - SBP standard deviation （ 24h - SBPSD ） （ P 〈 0. 05 and 0. 01 ） , of EH patients with T2DM were all significantly higher than those of EH patients without T2DM respectively. Conclusions T2DM could aggravate hypertension- induced abnormality in both struoture and function of cardiovascular systems, and then increase ABP and BPV. Therefore improvement of insulin senoitivity in those EH subjects with impaired glucose metabolism might restore cardiovascular hemodynamies, thus stabilizing the blood pructuation and reducing ghe possibility of caediovase complications.