老年原发性高血压患者血压变异性及其对血管内皮功能的影响

Effect of blood pressure variability on vascular endothelial function in elderly patients with essential hypertension

目的 探讨老年高血压病患者血压波动的程度及其对血管内皮细胞功能的影响.方法 随机选择2009年1月～2012年12月上海市浦东新区浦南医院年龄≥60岁的老年高血压患者65例（高血压组）和老年健康体检者52例（对照组）,以动态血压监测仪监测24 h血压变化,检测血浆血浆血管性血友病因子（vWF）、一氧化氮（NO）和内皮素-1（ET-1）水平.结果 高血压组昼间、夜间及24h收缩压变异性显著高于对照组（P=0.000）；高血压组血浆vWF水平显著高于对照组[（820.1±108.2）U/L比（648.4±128.3）U/L,P=0.000],ET-1水平明显高于对照组[（99.6±12.3）ng/L比（80.1±10.9）ng/L,P=0.000],而NO水平明显低于对照组[（42.0±6.6） μmol/L比（52.8±8.4） μmol/L,P=0.000],老年高血压组血浆vWF水平与24h收缩压变异性呈现显著正相关（r=0.518,P=0.006）.结论 老年高血压病患者血压变异性显著增高,并伴有血浆vWF、ET-1水平升高,提示内皮功能损害.

Objective To explore the characteristics of blood pressure variability and its effect on vascular endothelial function in elderly patients with essential hypertension. Methods Sixty five in-patients aged over 60 years with essential hypertension （hypertension group） from January 2009 to December 2012 in the Department of Cardiology of Shanghai Pu＇nan Hospital in Pudong New District, and 52 cases of healthy elderly controls with normal blood pressure from Check Center in Pu＇nan Health （control group） were randomly recruited. The blood pressure during daytime, nighttime and 24 h were monitored by ambulatory blood pressure monitor and the levels of plasma yon willebrand factor （vWF）, nitric oxide （NO） and endothelin-1 （ET-1） were measured＇for all patients in both group. The correlation between blood pressure variability and levels of plasma von willebrand factor, NO and ET-1 were respectively analyzed in each group. Results The systolic blood pressure variabilities （SBPV） during all time periods in hypertension group were significantly higher than those of control group. The plasma vWF level in hypertension group was significantly higher than that in control group [（820.1 ± 108.2） U/L vs （648.4 ± 128.3） U/L, P = 0.000], the level of plasma endothelin-1 in hypertension group was significantly higher than that in control group [（99.6 ± 12.3） ng/L vs （80.1 ± 10.9） ng/L, P = 0.000], while the level of NO was significantly lower than that in control group [（42.0 ± 6.6） μmol/L vs （52.8± 8.4）μmol/L, P = 0.000]. The plasma level of vWF was positively correlated with 24 h SBPV in hypertension group （r = 0.518, P = 0.006）. Conclusion Blood pressure variability in elderly patients with essential hypertension increase significantly, which is accompanied by elevation of plasma yon willebrand factor and ET-1 levels, indicating the existence of vascular endothelial impairment.