动态血压监测对老年体位性低血压评价的探讨

Orthostatic hypotension evaluated by ambulatory blood pressure monitoring in elderly patients

目的探讨动态血压监测（ABPM）技术对老年体位性低血压的评价价值。方法对152例门诊老年人进行卧位及立位3min血压测量，根据血压变化将患者分为体位性低血压组及非体位性血压组。对所有患者进行动态血压监测，计算并比较两组全天、白天以及夜间的平均血压、平均脉压、血压负荷、血压变异系数、动态动脉硬化指数以及24h血压昼夜节律。结果体位性低血压组的夜间平均收缩压、夜间平均舒张压、夜间收缩压负荷、夜间舒张压负荷、全天收缩压变异系数均高于非体位性低血压组，血压昼夜节律以反杓型为主。结论动态血压监测在老年体位性低血压的用药指导中有着重要的临床作用；老年体位性低血压存在夜间高血压、卧位高血压、收缩压波动范围大、血压昼夜节律异常的特点，上述特征均可造成重要靶器官的损伤。

Objective To investigate the value of ambulatory blood pressure monitoring （ABPM） for evaluating or- thostatic hypotension （OH） in elderly patients. Methods Blood pressure measurements of 152 aged people were obtained in a supine position and within 3 minutes after standing. They were divided into OH group and non-OH group according to blood pressure changes. All the patients were measured by ABPM. The mean blood pressure, mean pulse pressure （PP）, blood pressure load （BPL）, blood pressure variation coefficient （BPVC）, ambulatory arterial stiffness index （AASI） and the rhythm of blood pressure of two groups were calculated and compared during whole day, daytime and nighttime. Results The mean systolic blood pressure （SBP） and diastolic blood pressure （DBP） of nighttime, SBPL and DBPL of nighttime, SBPVC of whole day of OH group were higher than those of non-OH group. Reverse-dipper was the major pattern of blood pressure rhythm of OH group. Conclusions ABPM may be important in instructing medication to elderly patients with OH. Complication of night hypertension and supine hypertension, severe fluctuation of SBP and abnormal rhythm of blood pressure were commonly found, which may lead to target organs damage.