高血压患者动态血压参数与颈动脉内-中膜厚度关系的研究

A study on the relationship between ambulatory blood pressure monitoring parameters and carotid artery intima-media thickness in patients with hypertension

目的研究高血压病患者动态血压参数与颈动脉内-中膜厚度(CA-IMT)的关系。方法采用无创动态血压仪对127例高血压病患者进行24 h动态血压监测,同时应用高分辨率彩色多普勒超声显像仪测量患者颈动脉内-中膜厚度,据颈动脉内-中膜厚度分两组:CA-IMT≥0.9 mm为增厚组(n=53),CA-IMT<0.9 mm为正常组(n=74)。结果①CA-IMT增厚组与CA-IMT正常组的临床指标比较无统计学意义;②CA-IMT增厚组与CA-IMT正常组的动态血压参数比较:24 h平均收缩压(145.7±9.2)mmHg和(127.5±9.6)mmHg,24 h平均舒张压(83.5±5.1)mmHg和(76.7±5.6)mmHg,24 h脉压(62.3±10.1)mmHg和(47.8±9.5)mmHg;白天平均收缩压(148.6±6.3 mmHg)和(134.8±8.2)mmHg,白天平均舒张压(86.7±4.8)mmHg和(80.1±5.7)mmHg,白天脉压(63.5±10.9)mmHg和(51.4±9.1)mmHg;夜间平均收缩压(139.2±12.4)mmHg和(121.6±8.6)mmHg,夜间平均舒张压(79.3±9.0)mmHg和(70.3±5.2)mmHg,夜间脉压(60.1±11.7)mmHg和(50.4±7.1)mmHg,两者差异均有统计学意义(P<0.01)。CA-IMT增厚组与CA-IMT正常组其动态血压呈非勺型节律为54.7%比35.1%,其差异有显著性意义(P<0.05)。结论高血压病动态血压参数异常者颈动脉IMT增厚的发生率高,对靶器官损害有预测价值。

Objective To study the relationship between ambulatory blood pressure monitoring （ABPM） pa- rameters and carotid artery intima-media thickness（CA-IMT）in patients with hypertension. Methods One hundred and twenty-seven hypertensives including 89 males and 38 females were enrolled in this study . High resolution color Doppler uhrasonography was used to measure the CA-IMT,according to which the patients were classified into the in- creased IMT group（n= 53）or the normal IMT group（n= 74）. Twenty-four hours ABPM were performed in all the pa tients. Results （1）There were no significant differences between clinical manifestations and biochemical parameters between the two groups （ P〉0.05）. （2）The parameters of ABPM in the increased IMT group were higher than those in the non-increased IMT group. There were significant differences （ P 〈 0. 05） in 24h mean systolic blood pressure （145.7±9.2）mmHg vs. （127.5±9.6）mmHg,24h mean diastolic blood pressure（83.5±5.1）mmHg vs. （76.7±5.6） mmHg,24h pulse pressure（62.3±10.1）mmHg vs. （47.8±9.5）mmHg;daytime mean systolic blood pressure（148, 6 ±6.3 ）mmHg vs. （134.8±8.2）mmHg, daytime mean diastolic blood pressure（86.7±4.8） mmHg vs. （80.1±5.7） mmHg, daytime pulse pressure （63.5±10.9）mmHg vs. （51.4±9.1）mmHgnighttime mean systolic blood pressure （139.2±12.4）mmHg vs. （121.6±8.6）mmHg, nighttime mean diastolic blood pressure（79.3±9.0）mmHg vs. （70. 3±5.2）mmHg,nighttime pulse pressure（60.1±11.7）mmHg vs. （50.4±7.1）mmHg;and the non-dippers rhythm of ambulatory blood pressure54.7% vs. 35.1%. Conclusion Among the hypertensives with abnormal ABPM parameters,the increased IMT are more often seen which could be prognostic value in estimating the degree of target organ damage in hypertension.