老年高血压患者血压晨峰现象与颈动脉内膜中层厚度的关系

The relationship between morning blood pressure surge with carotid artery intima-media thickness in elderly hypertensive patients

目的 了解血压控制良好的老年高血压人群血压晨峰值与颈动脉内膜中层厚度（IMT）之间是否存在相关性。方法入选经药物控制良好的老年高血压患者151例。进行ABPM检查，计算血压晨峰值，按照血压晨峰值进行分组。血压晨峰值≤30mmHg者分为非血压晨峰组（NMS组），血压晨峰值〉30mmHg者分为血压晨峰组（MS组）。对入选对象进行颈动脉IMT测定。分析两组患者高血压相关因素对血压晨峰现象及IMT的影响，并对其血压晨峰值与IMT进行相关分析。结果两组151例高血压控制良好者，其中76例有血压晨峰现象，占50．3％。两组患者年龄、性别、体重指数、血脂、血糖、最高收缩压、平均收缩压、最低收缩压、最高舒张压、平均舒张压及最低舒张压比较，差异均无统计学意义（P〉0．05）。但MS组患者血压晨峰值[（42．34±7．10）mmHg]及IMT[（0．89±0．13）mm]高于NMS组[（21．16±5．23）mmHg，（0．84±0．14）mm，P〈0．01或P〈0．05]，颈动脉IMT与血压晨峰值呈正相关（r=0．56，P〈0．01）。结论血压控制良好的老年高血压人群仍存在血压晨峰现象，其血压晨峰值可能促进颈动脉粥样硬化。

Objective To study the relationship between morning blood pressure surge with carotid artery intima-media thickness in good controlled elderly hypertensive patients. Methods A total of 15i well controlled elderly hypertensive patients was selected in this study. Through the ABPM examination, the morning blood pressure peak was calculated, and then these patients were divided into two groups according to the morning blood pressure peak. The patients whose morning blood pressure peak ≤30 mmHg were divided into non-morning blood pressure surge group （ NMS group）, and the patients whose morning blood pressure peak 〉 30 mmHg were divided into morning blood pressure surge group （MS group）. The carotid IMT of these patients was measured with ultrasonic detection. The hypertension-related factors with blood pressure and morning peak phenomenon and the impact of IMT were analyzed, and the relationship between the morning blood pressure peak and IMT was analyzed with linear regression analysis. Results Two groups of 151 cases were well-controlled hypertension, 76 patients with morning blood pressure showed peak phenomenon, accounting for 50. 3%. Age, gender, body mass index, blood lipids, blood glucose, the maximum systolic blood pressure, average systolic blood pressure, minimum systolic blood pressure, maximum diastolic blood pressure, average diastolic blood pressure and minimum diastolic blood pressure had no difference between the two groups （ P 〉 0.05 ）. However, the morning blood pressure peak in patients with MS group [ （42. 34 ± 7.10 ） mmHg ] and IMT [ （ 0. 89 ± 0. 13 ） mm ] was higher than the NMS group [ （21.16 ±5.23） mmHg, （0. 84 ±0. 14） mm, P 〈0. 01 orP 〈0.05], and carotid IMT and peak morning blood pressure was positively correlated （ r = 0. 56, P 〈 0. 01）. Conclusions Good controlled elderly hypertensive patients remained the phenomenon of the morning blood pressure surge, the morning blood pressure peak might lead to carotid atherosclerosis.