老年高血压患者昼夜节律异常与颈动脉狭窄的相关性

Association of abnormal circadian blood pressure rhythm and carotid stenosis in the old patients with hypertension

目的探讨老年高血压病患者颈动脉狭窄与血压节律异常的关系。方法入选90例老年高血压患者,收集临床资料、动态血压监测、以及颈动脉超声资料。根据颈动脉是否狭窄将其分为颈动脉无狭窄组(n=35)和狭窄组(n=55)。比较两组之间的白天平均收缩压(dSBP)和舒张压(dDBP)、夜间平均收缩压(nSBP)和舒张压(nDBP)、夜间收缩压和舒张压下降率以及血压节律曲线。结果颈动脉狭窄和无狭窄组之间年龄、性别、糖尿病、高脂血症、左室射血分数以及服用药物等方面差异均无统计学意义。颈动脉狭窄组脑卒中发生率更高(P=0.046)。动态血压监测结果显示两组患者平均收缩压、舒张压无显著差异,但颈动脉狭窄组的夜间收缩压下降率、夜间舒张压下降率明显降低(P<0.05)。两组患者非杓型节律发生率无显著差异,颈动脉狭窄组反杓型节律更多(P=0.032)。结论夜间收缩压升高,即反杓型血压节律与老年高血压患者颈动脉狭窄高度相关。

Objective To investigate the relationship of abnormal circadian blood pressure rhythm and carotid stenosis in the old patients with hypertension. Methods Ninety old hypertensive subjects were enrolled. We collected informations on clinical data, carotid ultrasound, am bulatory 24 hour blood pressure monitoring. The patients were divided into stenosis group （ n = 55 ） and non stenosis group （ n = 35 ）. Day sys tolic blood pressure （dSBP） and diastolic blood pressure （dDBP） , night systolic blood pressure （nSBP） and diastolic blood pressure （nDBP） were compared between the two groups. Night blood pressure descend and blood pressure pattern were also observed. Results There were no sig nificant differences in age, gender, diabetes, hyperlipidemia and ejection fraction between two groups. Stroke increased significantly in carotid ste nosis group （ P = 0. 046）. The SBP and DBP had no difference in two groups. There was lower night blood pressure descend in stenosis group （ P 〈 0. 05 ）. More reverse dipper blood pressure pattern was observed in carotid stenosis group （ P = 0. 032）. Conclusion The reverse dipper blood pressure pattern is closely related to carotid stenosis in the old patients with hypertension.