老年高血压患者血压变异性及血压晨峰的相关因素

Correlative factors of blood pressure variability and morning blood pressure surge in elderly hypertensive patients

目的观察老年高血压患者血压变异性(BPV)及血压晨峰的相关因素。方法回顾性分析2002-01-01-2010-12-31中山大学附属第一医院心血管医学部行动态血压监测(ABPM)的住院和门诊高血压患者502例(年龄≥65岁)。根据年龄分为4组,65～<70岁(n=188)、70～<75岁(n=141)、75～<80岁(n=101)和≥80岁组(n=72),另入选年龄<65岁的高血压患者199例作为对照组。计算所有患者的BPV指标和血压晨峰(晨峰收缩压=睡-谷晨峰收缩压值=醒后2h平均收缩压-夜间睡眠时最低收缩压),并分析年龄、性别、糖尿病、吸烟强度及年限、体质量指数(BMI)、心率、血压昼夜模式对血压晨峰的影响。结果①在≥65岁的人群中,75～<80岁的晨峰收缩压(29.0±13.4)mmHg最高,≥80岁的晨峰舒张压(15.9±8.6)mmHg最低,差异有统计学意义。②与其他4组相比,年龄≥80岁组的24h平均收缩压、24h平均舒张压、白天平均收缩压、夜间平均收缩压和夜间平均舒张压的标准差及变异系数均明显升高,而白天平均舒张压标准差及变异系数差异无统计学意义。③与BMI<18.5kg/m2患者比较,BMI18.5～<25.0、25.0～<30.0和≥30.0kg/m2的晨峰收缩压较高(P<0.01);与不吸烟患者比较,吸烟年限≤30、>30～40、>40～50、>50年的晨峰收缩压较高(P<0.01)。④多重线性回归分析显示,BMI、吸烟年限、收缩压昼夜模式是晨峰收缩压的影响因素(P<0.01)。结论随着年龄的增加,老年高血压患者的BPV增大,晨峰收缩压也逐渐升高,BMI、吸烟年限和血压昼夜模式是其影响因素。

Objective To observe blood pressure variability （BPV） in the elderly by ambulatory blood pressure monitoring （ABPM） and evaluate the relationship between morning blood pressure surge {MBPS） and other cardiovascular risk factors. Methods From January 1, 2002 to December 31, 2010, 502 hypertensive inpatients and outpatients who underwent ABPM in the cardiovascular medicine department of the First Affiliated Hospital of SUN Yatsen University were retrospectively studied. They were divided into four groups according to the ages： group 65- 〈70（n=188）, group 70-〈75 （n=141）, group 75-〈80 （n=101） and group≥80 （n=72）. Another 199 hypertensive patients aged less than 65 were enrolled as control group. Indexes of BPV and MBPS were calculated. The SBP of MBPS was calculated as follows： MBPS mean systolic blood pressure （SBP） in two hours after awakening-lowest nighttime systolic blood pressure （nSBP）. Multi-factor statistical methods were used to evaluate the relationship between SBP of MBPS and other cardiovascular risk factors, such as age, gender, diabetes, smoking intensity and duration, body mass index （BMI}, heart rate and blood pressure rhythm. Results （Din the population aged over 65, the SBP of MBPS of group 75-〈80 was the highest（29.04±13.4）mm Hg, while that of group≥80 was the lowest （15.9 ± 8.6 ）mm Hg. The difference was statistically significant （ P〈 0.05 ）. ②Compared with those of the other four groups, the standard deviation and variation coefficient of 24 h systolic blood pressure （24hSBP）, 24 h diastolic blood pressure （24hDBP）, daytime systolic blood pressure （dSBP）, nSBP, and nighttime diastolic blood pressure （nDBP） in group ≥80 were significantly higher, but the differences in the standard deviation and variation coefficient of daytime diastolic blood pressure （dDBP） had no statistical significance.③SBP of MBPS of patients whose BMI 18.5-〈25.0, 25.0-〈30.0, and ≥30 kg/m2 were higher than that of those whose BMI were 〈18.5 kg/m2 （P〈0.01）. Furthermore, the SBP of MBPS of the patients who had a smoking history of no more than 30, 31 to 40, 41 to 50, and over 50 years was higher than that of the non-smoking patients （P〈0.01）.④Multiple linear regression analysis showed that BMI, smoking duration and circadian pattern of SBP affected the SBP of MBPS （P〈0.01）. Conclusions BPV and SBP of MBPS increase with age in the elderly hypertensive patients, and the BMI, smoking duration and circadian pattern of SBP were the influencing factors.