高血压并发急性心肌梗死与急性缺血性脑卒中患者血压变异性的差异

The difference of blood pressure variability between patients with hypertension complicated with acute myocardial infarction and stroke

目的探讨高血压并发急性心肌梗死与急性缺血性脑卒中患者血压变异性的差异,为更好地平稳降压提供科学依据。方法将临床诊断为高血压并急性心肌梗死患者设为A组,高血压并急性缺血性脑卒中患者设为B组,高血压未合并上述疾病者为C组;均给予动态血压检测,比较3组之间平均收缩压、平均舒张压、昼夜收缩压均值差异、昼夜舒张压均值差异、白天收缩压-标准差(SD)、夜间收缩压-SD、全天收缩压-SD、白天舒张压-SD、夜间舒张压-SD、全天舒张压-SD、白天收缩压-变异系数(CV)、夜间收缩压-CV、全天收缩压-CV、白天舒张压-CV、夜间舒张压-CV、全天舒张压-CV、晨峰(6:00～10:00)收缩压-SD、晨峰舒张压-SD、晨峰收缩压-CV、晨峰舒张压-CV。结果收缩压平均水平、SD、CV在3组之间显著性不同,以B组患者为高,A组患者其次,C组患者最低。舒张压平均水平、昼夜均值差异、夜间SD在3组之间差异无统计学意义,而白天舒张压的变异指标在A、B组患者中明显增高,两者之间差异无统计学意义。收缩压和舒张压的晨峰变异指标在3组之间差异均有统计学意义,其中又以B组的指标最高,A组患者最低。结论与单纯高血压患者相比,高血压并发急性心肌梗死和急性缺血性脑卒中患者血压变异性和晨峰血压存在差异,对上述患者应更平稳地降压。

Objective To investigate the difference of blood pressure variability （BPV） between the hypertension patients with acute myocardial infarction （AMI） or acute ischemic stroke. Methods A total of 204 hypertension patients were divided into three groups according to the complications： Group A （complicated with AMI） , Group B （complicated with acute ischemic stroke） , and Group C （no complication）. Patients were admitted to ambulatory blood pressure moni- toring （ABPM）. All markers, including mean systolic blood pressure （MSBP） , mean diastolic blood pressure （MDBP） , MSBP difference between day and night, MDBP difference between day and night, day SBP -SD, night SBP -SD, 24 h SBP- SD, day DBP- SD, night DBP - SD, 24 h DBP - SD, day SBP - CV, night SBP - CV, 24 h SBP - CV, day DBP - CV, night DBP - CV, 24 h DBP - CV, morning （6：013 - 10：00） SBP - SD, morning （6：00 ~ 10：00） DBP - SD, morning （6：00 ~ 10：130） SBP - CV and morning （6：00 ~ 10：00 ） DBP - CV ; were recorded for comparison. Results There were significant differences in MSBP, indexes of systolic blood pressure variability （ day and night） , day diastolic pressure variability and morning blood pressure variability among the three groups, which were all significantly highest in Group B and lowest in Group C. There were no significant difference in indexes of diastolic pressure and night indexes of blood pressure variability among the three groups. Conclusion BPV and the morning blood pressure surge are prominent in patients with hypertension complicated with AMI and stroke. The blood pressures homeostasis is more important in these patients.