老年高血压患者血压昼夜节律及颈动脉粥样硬化与认知功能损害

Ambulatory Blood Pressure Rhythm,Carotid Atherosclerosis and Cognition Function Damage in Very Elderly Hypertensives

目的探讨80岁以上老老年原发性高血压患者24 h动态血压节律及颈动脉粥样硬化对认知功能损害的影响。方法老老年原发性高血压受试者196例进行24 h动态血压及颈动脉超声监测,使用中文版简易智能状态检查表(MMSE)对受试者进行认知功能调查,MMSE总分范围为0～30分。结果血压昼夜节律与颈动脉粥样硬化对MMSE得分有显著影响,且有交互作用(F=5.937,P<0.05)。颈动脉粥样硬化者MMSE得分低于颈动脉非粥样硬化者[(19.5±2.1)比(23.1±3.0),P<0.01]。血压昼夜非杓型节律者MMSE得分低于血压昼夜杓型节律者[(19.7±2.3)比(22.9±3.1),P<0.01]。杓型血压昼夜节律与颈动脉硬化对MMSE中注意力和计算力及回忆力方面,有显著的交互作用(P<0.01),但对定向力、记忆力及语言表达能力方面无交互作用。结论血压昼夜节律减弱或消失及颈动脉粥样硬化,对老老年原发性高血压患者的认知功能损害有协同作用。

Objective To explore the relationship between 24 hours ambulatory blood pressure rhythm, carotid artery atherosclerosis and cognition function damage in oldest old （≥80 years） hypertensives. Methods Twenty-four hours ambulatory blood pressure monitoring （ABPM） and carotid artery ultrasonic examination were carried out in 196 very elderly hypertensives. Cognition function was evaluated by Mini-Mental State Examination （MMSE）. Results Significant relationship between ambulatory blood pressure rhythm and carotid artery atherosclerosis and MMSE were found. The interaction between ambulatory blood pressure rhythm and carotid artery atheroselerosis on MMSE（F=5. 937, P〈0.05） was demonstrated. MMSE was lower in carotid artery atherosclerosis subjects than that in normal subjects[（19.5±2.1）vs（23.1±3.0）, P〈0. 01]. Dipper hypertensives and non-dipper hypertensives had greater MMSE[（22. 9±3. 1） vs （19. 7±2.3）, P〈0. 01]. Ambulatory blood pressure rhythm and carotid artery atherosclerosis associated with various ingredient of MMSE. Interaction between ambulatory blood pressure rhythm and carotid artery atherosclerosis was shown in attention, calcula tion capability and recollection capability rather than on orientation memory and speech ability （P〈0. 01）. Conclusion Cognition function was damaged by synergistic effect of abnormal circadian rhythm of ambulatory blood pressure and carotid artery scleratheroma in very elderly hypertensives.