老老年原发性高血压患者脑白质病变与夜间血压下降率的相关性

Relationship between white matter lesions and percentage of nocturnal blood pressure decline in advanced aged patients with essential hypertension

目的探讨在老老年（≥80岁）原发性高血压患者中，动态血压状况与脑白质病变（WML）的相关性。方法我们回顾性地选取了高血压患者共130例，均行头颅磁共振检查和动态血压监测，并同时收集患者的临床和实验室数据，并应用年龄相关的脑白质视觉评定法评分将患者分为三组：轻度WML，中度WML，重度WML。结果在三组患者之间，夜间平均收缩压、夜间平均舒张压及夜间血压下降率的差异有统计学意义；并且与轻度WML组相比，中度WML和重度WML组患者非杓型血压的发生率显著升高。进一步的多因素logistic回归分析示，夜间舒张压升高和夜间血压下降率减小是WML的独立的危险因素。结论在老老年原发性高血压患者中，夜间血压异常升高以及昼夜节律的异常在WML的进展中起重要作用。

Objective To investigate the relationship between white matter lesions （WML） and ambulatory blood pressure in elderly essential hypertension. Methods Clinical and laboratory data of 130 patients （aged over 80 years） with essential hypertension who hospitalized in Department of Geriatric Neurology, Chinese PLA General Hospital during October 2007 to October 2011 were collected and retrospectively analyzed. They all received cerebral MR imaging and 24-hour ambulatory blood pressure monitoring. They were divided into 3 subgroups according to their white matter changes： mild WML, moderate WML and severe WML groups. Results There were significant differences in systolic and diastolic BP during night, and the percentage of nocturnal BP decline among the 3 groups of patients. Moreover, the prevalence of non-dipper was significantly higher in moderate and severe WML groups than mild WML group. Multiple logistic regression analysis showed that both diastolic BP at night and the percentage of nocturnal BP decline were independent risk factors of WML. Conclusion Elevated night-time BP and abnormal circadian blood pressure rhythm may play important roles in the development of WML in advanced aged patients with essential hypertension.