老年高血压患者动态脉压指数与靶器官损害的关系

Relationship between Dynamic Pulse Pressure Index and Target Organ Damage in Aged Patients with Primary Hypertension

目的探讨老年高血压患者动态脉压指数与靶器官损害的关系。方法选择60岁以上原发性高血压患者146例,按动态脉压指数水平分为3组:脉压指数≤0.40组(44例),脉压指数0.41～0.50组(56例),脉压指数≥0.51组(46例)。3组患者均化验血清肌酐,行动态血压、超声心动图、颈动脉超声、颅脑CT和(或)MRI检查;计算内生肌酐清除率(Ccr)、24h平均收缩压(24hMSBP)、24h平均舒张压(24hMDBP)、24h平均脉压(24hMPP)、脉压指数、左室重量指数(LVMI)、左室射血分数(LVEF)、左室舒张早期充盈峰值流速(E峰)及舒张晚期左房收缩期充盈峰值流速(A峰)比值(E/A)、颈动脉内膜-中层厚度(IMT)。结果3组患者左室肥厚、脑损害、肾功能损害及颈动脉斑块的患病率间差异均有统计学意义(P<0.05),脉压指数0.41～0.50组及脉压指数≥0.51组以上指标患病率与脉压指数≤0.40组比较,差异均有统计学意义(P<0.05),脉压指数≥0.51组以上指标患病率与脉压指数0.41～0.50组比较,差异均有统计学意义(P<0.05)。脉压指数≥0.51组LVEF<50%患病率与其他两组比较,差异均有统计学意义(P<0.05),E/A<1的患病率与脉压指数≤0.40组比较,差异有统计学意义(P<0.05,)。Spearman相关分析显示,动态脉压指数与心脑肾及颈动脉损害有相关性(均P<0.05)。结论老年高血压患者动态脉压指数增大与靶器官结构和功能的损害程度密切相关;动态脉压指数可以作为老年高血压患者靶器官损害的预测因子。

Objective To investigate the relationship between dynamic pulse pressure index （PPI） and target organ damage （TOD） in aged patients with primary hypertension. Methods One hundred forty - six elderly patients （ age 〉1 60 years） with primary hypertension were divided, according to dynamic PPI, into. groups A （ PPI≤0.40, n =44）, B （ PPI 0.41 -0.50, n=56）, and C （PPI≥0.51, n =46）. The tests of serum creatinine （Cr）, ambulatory blood pressure （aBP）, echocardiography （ECG）, carotid ultrasonography （CUS）, brain CT and （or） MRI were performed. Creatinine clearance rate （Ccr）, 24 -hour mean systolic blood pressure （24 h MSBP）, 24 - hour mean diastolic blood pressure （24 h MDBP）, 24- hour mean pulse pressure （24 h MPP）, PPI, left ventricular mass index （LVMI）, left ventricular ejection fraction （LVEF）, the ratio of left ventricular early diastolic filling peak flow velocity （E peak） and left atrial systolic filling peak flow velocity in late diastolic phase （A peak） （E/A）, and carotid artery intimamedia thickness （IMT） were detected. Results The mean levels of LVMI, carotid IMT and the prevalence of left ventricular hypertrophy, brain damage, kidney function damage, carotid plaque were significantly higher in groups B and C than in group A （P 〈0. 05）, and higher in group C than in group B. The mean levels of Ccr and LVEF were significantly lower （ all P 〈 0. 05 ）, and the incidence of E/A 〈 1 higher in group C than in group A （ P 〈 0. 01 ）. Spearman correlation analysis indicated that the level of dynamic PPI was strongly correlated with damages of heart, brain, kidney and carotid artery （P 〈0. 05 ）. Conclusion Elevated dynamic PPI, closely correlated with the severity of TOD in structure and function, can be used as a predictor in aged patients with primary hypertension.