中老年男性高血压患者血压晨峰临床分析

A clinical analysis of morning blood pressure surge in middle and old aged male hypertensive patients

目的 研究中老年男性高血压患者血压晨峰发生情况与血压变异性、降压药物的关系.方法 对2009年1月至2010年12月住院或体检的中老年军人进行问卷及体格检查、实验室检查及动态血压监测,并根据血压晨峰程度是否超过35 mm Hg（1 mm Hg =0.133 kPa）分为晨峰组（101例）和非晨峰组（420例）进行组间比较.结果 中老年男性高血压患者血压晨峰的发生率为19.4％,其中老年和超高龄患者血压晨峰患病率高于中年患者（18.9％、21.8％、5.6％,P＜0.01）；与非晨峰组比较,晨峰组具有较高的日间平均收缩压[（132.8±13.3） mm Hg比（128.8±13.3）mm Hg]、空腹血糖水平[（5.96±1.59） mmol/L比（5.68±1.22） mmol/L,P＜0.05]以及24h血压变异性；服用利尿剂组晨峰发生率较未服用组高（27.4％比17.6％,P＜0.05）.结论 老年高血压患者易出现血压晨峰现象,空腹血糖水平、24h血压变异性可能是血压晨峰的影响因素,利尿剂可能不利于血压晨峰的控制.

Objective To investigate the morning blood pressure surge（MBPS） and its relationship with 24-hour blood pressure variability and anti-hypertensive drugs in middle-aged and elderly hypertensive patients.Methods A total of 521 middle-age and elderly men were surveyed with ambulatory blood pressure monitoring and ambulatory electrocardiograms recordings as well as questionnaire investigation from January 2009 to December 2010.Subjects were divided into MBPS positive group and MBPS negative group according to the level of MBPS[ 〉35 mm Hg （1 mm Hg=0.133 kPa） or ≤35 mm Hg].Results In all the cases,the prevalence of MBPS was 19.4%,of which the elderly and very elderly had higher prevalences （ 18.9% and 21.8%,respectively） than the middle-aged （5.6%,both P 〈0.01 ）.Significant differences could be found in age [ （ 81.6 ± 6.4 ） years vs （ 78.7 ± 9.7 ） years ],day mean systolic blood pressure [ （ 132.8 ± 13.3） mm Hg vs （ 128.8 ±13.3） mm Hg],fasting blood glucose [ （5.96 ± 1.59） mmol/L vs （5.68 ± 1.22） mmol/L] and 24-hour blood pressure variability between the two groups （ all P 〈 0.05 ）.Significant difference could be observed in the prevalence of MBPS between the diuretics-taking group and non-taking group （27.4% vs 17.6%,P 〈0.05 ）.Conclusions The elderly hypertensive patients are prone to appear MBPS phenomenon.Fasting blood glucose level,24-hour blood pressure variability may be associated with MBPS.Diuretic antihypertensive treatment may not be conductive for MBPS control.