原发性高血压患者血压晨峰与颈动脉硬化、动脉僵硬度的相关性分析

Relationship of morning blood pressure surge with carotid atherosclerosis and arterial stiffness in patients with essential hypertension

目的探讨原发性高血压人群血压展峰现象与颈动脉内膜中层厚度（CCA—IMT）、颈动脉斑块以及肱一踝动脉脉搏波速度（baPWV）的相关性。方法对入选的原发性高血压患者128例进行24h动态血压监测，根据结果分为展峰组49例和非展峰组79例，两组均进行颈动脉超声检查，测量CCA—IMT和颈动脉斑块，同时进行baPWV检测，比较两组CCA—IMT、颈动脉斑块以及baPWV的差异。结果展峰组的CCA—IMT（1．12±0．21）mm、斑块检出率87．76％、斑块的平均厚度（1．35±0．33）mm、baPWV（1629．9±223．5）cm／s，均高于非展峰组[（0．97土0．34）mm、68．35％、（1．21±0．24）mm、（1507．6s±247．6）cm／s]（P〈0．05或0．01）。多元Logistic逐步回归分析结果显示，仅血压晨峰为CCA—IMT及baPWV值增大的独立危险因素，OR值及95％C1分别为：1173（0．97～428）和2．26（1．84～6．78）（均P〈0．01）。结论血压晨峰可能与动脉粥样硬化和动脉弹性功能减退有关。

Objective To investigate the relationship of morning blood pressure surge with carotid intima-media thick- ness （CCA-IMT）, carotid arteries plaque,brachial-ankle pulse wave velocity （baPWV） in patients with essential hypertension. Methods According to the results of 24 h ambulatory blood pressure monitoring, 128 patients were classified as the morning BP surge （MBPS group, n=49） or non-morning BP surge （NMBPS group, n=79）. Patients underwent carotid ultrasonography, CCA-IMT and plaques were examined and the baPWV were also measured. Results In the MBPS group,the CCA-IMT [（1.12 ± 0.21） mm vs （0.97 ± 0.34）mm], the detection rate of plaques （43/49 vs 54/79 ）, the average thickness of carotid arteries plaque [（1.35 ±0.33）mm vs （1.21 ±0.24）mm], the baPWV [（1629.9 ± 223.5）cm/s vs （1507.6 ± 247.6）cm/s] were higher than those in NMBPS group （P〈0.05 or 0.01）. Multivariate logistic regression analysis showed that MBPS was independent risk factor of increased CCA-IMT （OR=1.73, 95%C1： 0.97-4.28） and baPWV （OR=2.26, 95%C1：1.84-6.78, P〈0.01）. Conclusion Morning blood pressure surge in patients with essential hypertension is associated with carotid atherosclerosis and damage of aortic elasticity.