老年男性原发性高血压患者脉压与颈动脉狭窄的相关分析

The correlation analysis of carotid stenosis and pulse pressure in the elderly men with essential hypertension

目的:探讨老年男性原发性高血压(EH)患者脉压(PP)与动脉粥样硬化性颈动脉狭窄(CS)的关系。方法:对入选的157例伴有颈动脉粥样硬化的老年男性EH患者行颈动脉超声检查,并收集行颈动脉超声检查前1年内的多次血压水平及临床资料,根据颈动脉狭窄程度分为:CS<50%组(n=66)及CS≥50%组(n=91),并进一步将颈动脉狭窄程度分级(Ⅰ～Ⅴ级),分析颈动脉狭窄的危险因素及与脉压的相关性。结果:①CS≥50%组收缩压(SBP)及PP显著高于CS<50%组,而舒张压(DBP)显著低于CS<50%组(P<0.05),CS≥50%组的独立危险因素是外周动脉疾病(OR:4.543,95%CI:1.415-14.590)及脉压(OR:1.096,95%CI:1.038-1.157);②CS分级与PP(r=0.402,P<0.01)及血浆纤维蛋白原(FIB)(r=0.200,P<0.05)呈正相关,经校正年龄、体重指数(BMI)、SBP、DBP、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)、D-二聚体(D-dimer)、血尿酸(UA)、空腹血糖(FBG)、氨基酸末端脑利钠肽前体(NT-proBNP)、总胆红素(TBIL)及直接胆红素(DBIL)等危险因素后,CS分级仍与PP及FIB有关。结论:老年男性原发性高血压患者脉压与颈动脉狭窄有关,治疗高血压的同时应当尽量减小脉压。

Objective： To investigate the relationship between the carotid stenosis （CS） and the pulse pressure （PP） in elderly men with essential hypertension. Methods： According to the Color Doppler Flow Imaging （CDFI）, 157 elderly men with essential hypertension and carotid atheroselerosis were divided into five classifications and two groups： CS 〈 50% group （ n = 66） and CS≥50% group （ n = 91）. The blood pressures were measured within one year before the CDFI was taken and clinical data were recorded, Results： （1）The systolic blood pressure （SBP） and the PP in CS≥50% group were significantly increased than those in CS 〈 50% group, while the diastolic blood pressure （DBP） was converse. The independent risk factors of CS≥50% were peripheral arterial disease （OR： 4.543, 95%CI： 1.415 - 14.590） and PP （OR： 1.096, 95%CI： 1.038- 1.157）. QCS classifications positively correlated with PP （r =0.402, P 〈0.01） and fibrinogen （FIB） （r= 0.200, P 〈0.05）. After adjusting for age, body mass index （BMI）, SBP, DBP, total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-c）, high density lipoprotein cholesterol （HDL-c）, fasting serum glucose （FBG）, blood uric acid （UA）, D- dimer, amino-terminal pro-brain natriuretic peptide （NT-proBNP）, total bilirubin （TBIL） and direct bifiruhin （DBIL）, multiple regression analysis showed that PP and FIB remained as predisposing risk factors for CS classifications. Conclusion： The pulse pressure was correlated with carotid stenosis in elderly men with essential hypertension and it was justified for concurrent inhibition of PP in the treatment of high blood pressure.