原发性反杓型高血压老年男性患者靶器官损害的危险因素分析

Target organ damage in aged men with essential anti-dipper hypertensive

目的分析原发性反杓型高血压老年男性患者的靶器官损害、血压形态和危险因素。方法共收入我院心内科2009-2012年老年男性原发性非杓型高血压患者651例,分为非杓型组(206例)与反杓型组(445例),检查生化全项,计算人体质量指数(body mass index,BMI);行心脏超声检查,计算左心室质量指数。结果与一般非杓型高血压患者相比,反杓型高血压组年龄偏高,BMI较低,多合并糖尿病、慢性肾病及脑梗死病史,空腹血糖水平、低密度脂蛋白、肌酐水平较高,血红蛋白偏低。清晨收缩压、24 h舒张压、白天舒张压较低,清晨舒张压、24 h收缩压、夜间收缩压、夜间舒张压较高。左心室后壁、左心室收缩期内径较高,射血分数较低(P<0.05);空腹血糖升高、慢性肾病、脑梗死均是反杓型高血压的独立危险因素(P<0.05)。结论老年男性原发性反杓型高血压是复杂的疾病,受多种因素的相互作用,空腹血糖升高、慢性肾病、脑梗死是老年男性原发性反杓型高血压的危险因素。

Objective To explore target organ damage, blood pressure form and risk factors in aged men with essential anti-dipper hypertensive. Methods Six hundred and fifty-one patients admitted to our hospital from 2009 to 2012 were divided into non-dipper hypertensive group （n=206） and anti-dipper hypertensive group （n=455）. Body mass index （BMI） and left ventricular mass index （LVMI） were calculated by undergoing physical-biochemical items and heart ultrasonography, respectively. Results Compared with non-dipper hypertensive group, the age of anti-dipper hypertensive group was older, the BMI was lower, and the incidence of diabetes mellitus, cerebral infarction, renal insufficiency was significantly higher. The FPG, LDL-C, Cr were higher in anti-dipper hypertensive group while hemoglobin was lower. Morning SBP, 24 h DBP, dDBP were lower whereas morning DBP, 24 h SBP, nSBP and nDBP were higher in anti-dipper hypertensive group than in non-dipper hypertensive group. The numerical value of left ventricular posterior wall and left ventricular systolic diameter went higher with lower ejection fraction in anti-dipper hypertensive group （P 〈 0.05）. Thus, higher FPG, cerebral infarction and renal insufficiency were the independent risk factors for anti-dipper hypertensive （P 〈 0.05）. Conclusion Anti-dipper hypertensive is a complex syndrome in aged men. Higher FPG, cerebral infarction and renal insufficiency are its main risk factors.