动态脉压对老年男性高血压患者颈动脉粥样硬化病变进展的影响

Ambulatory pulse pressure predicts progression of carotid arteriosclerosis in two years in elderly men with primary hypertension

目的探讨动态脉压(pulse pressure,PP)对颈动脉粥样硬化病变进展的影响。方法选择102例老年男性原发性高血压患者,所有患者均做动态血压监测(ABPM)及颈动脉超声,随访2年后复查颈动脉超声,出现以下三者之一即为颈动脉病变进展(total progress of carotid,TPC)病例:①颈动脉狭窄加重(PCS);②新出现颈动脉复杂斑块(CP);③颈动脉内-中膜厚度(IMT)进展(IIMT)。统计分析动态PP对TPC的影响。根据ABPM测量,102例老年男性高血压患者依次被分为24小时PP升高组(51例)与对照组(51例),白天PP(dPP)升高组(55例)与对照组(47例),夜间PP(nPP)升高组(40例)与对照组(62例)。结果①102例患者中,总计TPC 71例(69.6%),其中,PCS病例28例(27.5%),新出现CP病例52例(51.0%),IIMT病例22例(21.6%),所有患者在随访期间未出现急性心肌梗死及有后遗症的脑血管病,无死亡病例。②全天PP(24PP)升高组TPC(80.4%vs 58.8%,χ2=5.607)及PCS(39.2%vs 15.7%,χ2=7.089)的患者比例均显著高于对照组(P<0.05);dPP升高组TPC(80.0%vs 57.4%,χ2=6.093)及PCS(36.4%vs 17.0%,χ2=4.761)的患者比例均显著高于对照组(P<0.05);nPP升高组TPC(87.5%vs 58.1%,χ2=9.958,P<0.01)、PCS(42.5%vs 17.7%,χ2=7.482,P<0.05)及新出现CP(65.0%vs 41.9%,χ2=5.176,P<0.05)的患者比例显著高于对照组。③多因素分析结果:nPP≥60mmHg(OR=5.909,95%CI=1.860～18.733,P<0.01)为TPC的独立危险因素(P<0.01)。结论动态PP尤其是nPP可以预测老年男性高血压患者2年后的TPC程度。

Objective To investigate whether ambulatory pulse pressure（PP） can be used to predict the progression of carotid arteriosclerosis. Methods A total of 102 elderly hypertensive men with carotid arteriosclerosis were enrolled in this study. All the patients underwent ambulatory blood pressure monitoring （ABPM） at baseline. Carotid ultrasound investigations at baseline and after a median of 23 months （range,20 to 29 months） were performed to identify patients with progressive carotid arteriosclerosis. Total progression of carotid disease （TPC） was defined as according to any one of the follows：（1）progression of carotid artery stenosis （PCS） （2）new complex plaques （CP） of any arteries （CCA and extracranial ICA） ;（3）increasing of carotid artery intima-media thickness （IIMT）. Then, the effect of ambulatory PP to predict the progression of carotid arteriosclerosis was evaluated. According to ABPM measure, 102 elderly hypertensive men were respectively divided into two paired match groups, 24 h PP raised group（ n = 51） vs control group（ n =51）,day PP （dPP） raised group（ n=55） vs control group（ n =47）,night PP（nPP） raised group （n = 40） vs control group （ n = 62）. Results （1） In all 102 patients, TPC was found in 71 patients （69. 6%） by ultrasound with PCS in 28 patients（27.5%） ,new CP in 52 patients（51.0%） and IIMT in 22 patients（21.6%）. All the patients had no AMI or disabling cerebrovascular desease and no patients died in the follow-up. @Patients with elevated 24 hPP had significantly increased risk for TPC（80.4% vs 58.8%,X2= 5. 607） and PCS（39.2% vs 15.7%, x2= 7. 089） compared with the patients in the control group （ P〈 0.05）. Patients with elevated dPP had significantly increased risk for TPC（80.0 %vs 57.4 %, X2 = 6. 093 ） and PCS （36.4 % vs 17.0 %, X2 = 4.761 ） compared with the patients in the control group（ P〈0.05）. Patients with elevated nPP had significantly increased risk for TPC（87.5 % vs 58.1%,x2=9.958, P〈0.01）,PCS（42.5% vs 17.7%, 2=7.482, P〈0.05） and newCP165.0% vs41.9%,x2=5. 176, P〈0.05） compared with the patients in the control group.（3）Multivariable analysis showed nPP≥60 mmHg （OR =5.909,95% CI =1.860-18.733, P M0.01） was independent factor for TPC（P %0.01）.Conclusion Ambulatory PP especially nPP can be used to predict the progression of carotid arteriosclerosis in two years in the elderly men with hypertension.