不同降压策略改变血压变异性对高血压脑白质病变的影响

Effect of the change in blood pressure variability on white matter lesions under different antihypertensive strategies in hypertensive patients

目的探讨不同降压策略下血压变异性改变对高血压患者脑白质病变(WMLs)的影响。方法连续收集2013年1月至2018年3月于郑州人民医院神经内科住院的高血压患者274例,入院后第2天均行动态血压(ABP)及头部MRI检查。按照有无WMLs,分为3组,即无病变组(72例)、轻中度病变组(120例)及重度病变组(82例)。对比各组患者临床资料特点,对影响WMLS的危险因素进行多因素分析。分析应用不同类别降压药物下,血压变异性及WMLs病变程度比较。结果 24 h收缩压变异系数和24 h收缩压标准差在3组间比较,差异有统计学意义(χ2=32. 492,P=0. 000;χ2=25. 518,P=0. 000)。24 h收缩压变异系数和24 h收缩压标准差为WMLs的独立危险因素(OR=2. 987,95%CI:1. 537～5. 806,P=0. 001; OR=2. 046,95%CI:1. 042～4. 018,P=0. 038)。钙离子拮抗剂类药物应用较β受体阻滞剂类药物应用患者的血压变异性低、WMLs病变程度轻,差异均有统计学意义(χ2=16. 615,P=0. 000;χ2=18. 972,P=0. 000)。结论 24 h收缩压标准差及变异系数是预测WMLs的较好且简易指标,避免血压剧烈波动及应用适当类别的降压药物是预防WMLs的有效措施。

Objective To investigate the effect of the change in blood pressure variability on white matter lesions( WMLs) under different antihypertensive strategies in hypertensive patients. Methods A total of 274 hypertensive patients who were consecutively admitted to the Department of Neurology in Zhengzhou People’s Hospital from January 2013 to March 2018 were enrolled. Ambulatory blood pressure( ABP) measurement and head MRI were performed on day 2 after admission. According to the presence or absence of WMLs,these patients were divided into non-WML group with 72 patients,mild-to-moderate WML group with 120 patients,and severe WML group with 82 patients. Clinical data were compared between groups,and a multivariate analysis was performed to identify the risk factors for WMLs. Blood pressure variability and the severity of WMLs were compared between patients treated with different antihypertensive drugs. Results There were significant differences between the three groups in 24-hour coefficient of systolic pressure variation and 24-hour standard deviation of systolic pressure( χ^2= 32. 492 and 25. 518,P = 0. 000 and 0. 000). The 24-hour coefficient of systolic pressure variation( odds ratio [OR]= 2. 987,95% confidence interval [CI]:1. 537-5. 806,P = 0. 001) and 24-hour standard deviation of systolic pressure( OR = 2. 046,95% CI: 1. 042-4. 018,P = 0. 038) were independent risk factors for WMLs. Compared with those treated with β-receptor blocker,the patients treated with calcium antagonists had significantly lower blood pressure variability( χ^2= 16. 615,P = 0. 000) and severity of WMLs( χ^2= 18. 972,P = 0. 000). Conclusions The 24-hour standard deviation and coefficient of systolic pressure variation are good and simple indices for predicting WMLs. Avoiding drastic fluctuation of blood pressure and using appropriate antihypertensive drugs are effective measures for the prevention of WMLs.