老年男性动脉硬化血压波动与脑梗死发生的关系

Association of blood pressure variability and cerebral infarction in elderly men with atherosclerosis

目的 探讨血压波动对老年男性脑梗死发生的影响.方法 1527例患有动脉硬化的老年（年龄＞65岁）男性患者,所有患者监测动态血压,根据有无脑梗死将入选患者分为2组：脑梗死组（607例）和非脑梗死组（920例）,用数学平滑曲线方法先将每一个体24 h血压数据进行分析,再描绘出一条适合个体血压变化趋势的曲线,计算实际血压值与该趋势曲线相应位置所形成差值的标准差即为血压波动值,然后比较2组血压波动的情况.结果 脑梗死组中24 h的收缩压波动值明显高于非脑梗死组[（8.4±2.2）与（8.0±2.0）mm Hg,t=-2.909,P＜0.01];其中自昼收缩压血压波动明显升高[（8.2±2.2）与（7.8±2.1）mm Hg,t=-2.969,P＜0.01];而夜间收缩压波动2组差异无统计学意义[（8.9±3.9）与（8.7±3.7）mm Hg,P＞0.05];各阶段舒张期血压波动差异无统计学意义[24 h舒张压波动值（5.5±3.8）与（5.5±1.5）mm Hg,P＞0.05;白昼舒张压波动值（5.4±1.5）与（5.3±1.4）mm Hg,P＞0.05;夜间舒张压波动值（6.1±2.7）与（6.1±2.6）mm Hg,P＞0.05].结论 在老年男性动脉硬化相关疾病患者中,脑梗死的发生与白昼收缩压的波动密切相关,而与夜间收缩压和舒张压波动无关.

Objective , To investigate the influence of blood pressure variability on cerebral infarction in older men. Methods Ambulatory blood pressure was measured in 1527 elderly men （ older than 65 yrs） with atherosclerosis. All cases were divided into 2 groups： Six hundred and seven patients with cerebral infarction （ group A）and 920 patients without cerebral infarction （ group B）. Smooth curve method was used to analyze each patient＇s ambulatory blood pressure data and the trend of each patient＇s blood pressure curve was portrayed. The differences between the actual blood pressure and the blood pressure on the curve was defined as blood pressure variability,and the blood pressure variability between the 2 groups was compared. Results The systolic blood pressure variability in 24 hours in group A was significantly higher than that in group B（ [8.4＇±2. 2]mm Hg vs [ 8.0 ± 2. 0 ] mm Hg, P 〈 0. 01 ）, especially for the systolic blood pressure variability in daytime（ [ 8. 2 ± 2. 2 ] mm Hg vs [ 7. 8 ± 2. 1 ] mm Hg, P 〈 0. 01 ）. However, the systolic blood pressure variability at night was not significantly different between the 2 groups（ [ 8.9 ± 3. 9 ] mm Hg vs [ 8. 7 ± 3.7 ] mm Hg,P 〉 0. 05 ）. There were no significant difference between the diastolic blood pressure of 24 hours（ [5. 5 ± 3.8 ] mm Hg vs [5.5 ± 1.5 ]mm Hg,P 〉0. 05）,during daytime（[5.4 ± 1.5]mm Hg vs [5.3 ± 1.4] mm Hg,P 〉0.05）and nighttime （ [ 6. 1 ± 2.7 ] mm Hg vs [ 6. 1 ± 2. 6 ] mm Hg, P 〉 0. 05 ）. Conclusion In elderly men with atherosclerosis,cerebral infarction was closely related to systolic blood pressure variability,but independent of nighttime systolic blood pressure and diastolic blood pressure variability.