北京某社区50岁以上人群日间血压变异性影响因素分析

Risk factors of daytime blood pressure variability in people over 50 years old in a community of Beijing

目的 探讨北京某社区50岁以上人群日间血压变异性影响因素.方法 随机招募北京市某社区50岁以上人群100人参加血压远程监测.每天早（6：00-10：00）、晚（16：00-22：00）各测量血压1次,监测时间为3个月,监测结束后随访,收集研究对象人口统计学指标、疾病史、服药史、行为危险因素等数据.结果 从招募的100人中选出数据完整的研究对象共65人,男性占49.2％（32/65）,平均年龄（60±7）岁,体重指数为（25.4±3.2） kg/m2.非糖尿病受检者（43人）早晨时段收缩压变异性明显低于有糖尿病者（10人）[（9.7±2.2）mmHg（1 mmHg =0.133 kPa）比（11.4 ±4.2） mmHg],不吸烟受检者（38人）晚间时段舒张压变异性明显低于吸烟者（15人）[（6.1 ±1.2）mmHg比（7.1±1.3）mmHg],差异均有统计学意义（P＜0.05）.早晨时段,使用钙通道阻滞剂联合血管紧张素转换酶抑制剂降压者（8人）收缩压、收缩压变异性、舒张压明显高于血压正常者（17人）[（136±14） mmHg比（121±10） mmHg、（11.6±4.8）mmHg比（8.5±1.4） mmHg、（81 ±7） mmHg比（72 ±7） mmHg],差异有统计学意义（P＜0.05）.晚间时段,单用钙通道阻滞剂降压者（17人）舒张压明显高于血压正常者（23人）[（79±5）mmHg比（73±7）mmHg],差异有统计学意义（P＜0.05）.在多因素分析中,早晨时段,平均收缩压每升高20 mmHg,收缩压变异性将升高2.583 mmHg,饮酒者收缩压变异性比不饮酒者降低了1.335 mmHg;有糖尿病者相对于无糖尿病者收缩压变异性升高了1.913mmHg.晚间时段,平均舒张压水平每升高10 mmHg,舒张压变异性升高0.754 mmHg,吸烟者舒张压变异性比不吸烟者增高0.716 mmHg.结论 收缩压水平、糖尿病、适量饮酒是早晨时段日问收缩压变异性的独立影响因素.舒张压水平、吸烟是晚间时段日间舒张压变异性的独立影响因素.

Objective To investigate the risk factors of daytime variability in blood pressure in people over 50 years old in a community of Beijing. Methods Totally 100 volunteers in a community of Beijing were recruited randomly and underwent remote monitoring of blood pressure once every morning （ 6 ： 00- 10 ： 00 ） and once every evening （ 16 ： 00-22 ： 00 ）. After observation of 3 months, data including demographic indicators, medical history, medication history and behavioral risk factors were observed. Results Totally 65 subjects had complete data, among them 49.2% were male, the age was （ 60 ±7 ） years and the BMI was （25.4 ± 3.2 ） kg/m2. In the morning, the systolic blood pressure variability of non-diabetic subjects was significantly lower than that of diabetes mellitus subjects [ （ 9.7 ± 2.2 ） mmHg vs （ 11.4 ± 4.2） mmHg, P 〈 0.05 ] ; in the evening, the diastolic blood pressure variability of non-smoking subjects was significantly lower than that of smokers [（6. 1 ± 1.2）mmHg vs （7. 1 ± 1.3）mmHg, P〈0.05]. In the morning, the systolic blood pressure, systolic blood pressure variability and diastolic blood pressure of sub- jects who used calcium channel blockers combined with angiotensin converting enzyme inhibitor were signifi- cantly higher than those of normotensives [ （ 136 ± 14） mmHg vs （ 121 ± 10） mmHg, （ 11.6 ±4.8） mmHg vs （8.5±1.4） mmHg,（81±_7） mmHgvs （72±7） mmHg, allP〈0.051. In the evening, the diastolic blood pressure of subjects who used calcium channel blockers was significantly higher than that of normoten- sives [ （79 ± 5 ） mmHg vs （ 73 ± 7 ） mmHg, P 〈 0.051 ] Multivariate analysis showed that for systolic blood pressure, 20 mmHg increment was associated with 2. 583 mmHg raise of variability, 1. 335 mmHg lower of variability for drinkers compared with non-drinkers and 1.913 mmHg higher of variability for diabetic subjects compared with non-diabetic subjects; for diastolic blood pressure, 10 mmHg increment was associated with 0. 754 mmHg raise of variability and 0. 716 mmHg higher of variability for smokers compared with non-smokers. Conclusions The systolic blood pressure, diabetes and moderate drinking are the independent factors of the daytime systolic blood pressure variability in the morning, the diastolic blood pressure and smoking are the independent factors of the daytime diastolic blood pressure variability in the evening.