老年高血压病晨峰现象分析

Phenomenon of morning blood pressure surge in elderly patients with hypertension

目的 通过观察住院老年原发性高血压患者血压晨峰现象的变化,分析晨峰现象发生及其与体质指数、血糖、血脂水平的相关性。方法 选择自2012年9月~2013年9月住院的患者,共入选原发性高血压256例,其中男性112例,平均年龄（70.89±2.76）岁;女性144例,平均年龄（69.78±2.67）岁。根据所有研究对象收缩压是否存在晨峰现象分为两组,即晨峰组124例和非晨峰组132例,24h血压进行对比,并分析晨峰血压与体质指数、血糖、总胆固醇、低密度脂蛋白胆固醇、三酰甘油、高密度脂蛋白胆固醇的相关性,探讨体质指数、血糖水平、血脂水平与晨峰血压之间的关系。结果 晨峰组与非晨峰组相比,晨峰组24 h动态收缩压、日间动态收缩压、夜间动态收缩压、24 h动态脉压、日间动态脉压、夜间动态脉压都高于非晨峰组（t值分别为2.991、2.045、4.441、6.713、2.861、2.281;P值分别为0.004、0.044、0.0001、0.011、0.005、0.025）,差异具有统计学意义。通过多元性性回归分析原发性高血压患者中高密度脂蛋白与晨高血压呈负相关,体质指数、血糖、血脂与晨峰血压呈正相关,与非晨峰组相比,晨峰组的空腹血糖水平、血脂水平、体质指数均高于非晨峰组,两组比较差异有统计学意义（P均〈0.001）。结论 体质指数、血糖水平、总胆固醇、低密度脂蛋白、三酰甘油是晨峰高血压发生的危险因素,故应在控制血压的同时适当减重、降糖、调脂治疗。

Objective To analyze the phenomenon of morning blood pressure surge （MBPS） and relationship among it and body mass index （BMI）, plasma glucose and blood fat through observing the changes of MBPS in elderly patients with primary hypertension. Methods The patients （n=256, male 112 and average=70.89± 2.76, and female 144 and average=69.78±2.67） were chosen from Sept. 2012 to Sept. 2013. According to MBPS phenomenon of systolic blood pressure （SBP）, the patients were divided into MBPS group （n=124） and non-MBPS group （n=132）. The changes of 24-h blood pressure （BP） were compared, and correlation among MBPS and BMI, plasma glucose, total cholesterol （TC）, low-density lipoprotein-cholesterol （LDL-C）, triglyceride （TG） and high-density lipoprotein-cholesterol （HDL-C） was analyzed. The relationship between BMI, plasma glucose and blood fat and MBPS was discussed. Results In MBPS group, 24-h ambulatory SBP （t=2.991, P=0.004）, daytime ambulatory SBP （t=2.045, P=0.044）, nighttime ambulatory SBP （t=4.441, P=0.0001）, 24-h ambulatory pulse pressure （PP, t=6.713, P=0.011）, daytime ambulatory PP （t=2.861, P=0.005） and nighttime ambulatory PP （t=2.281, P=0.025） were all higher than those in non-MBPS group. The results of multi-regression analysis showed that HDL-C was negatively correlated to MBPS, and BMI, plasma glucose and blood fat were positively correlated to MBPS. Fasting plasma glucose, blood fat and BMI were higher in MBPS group than those in non-MBPS group （all P〈0.001）. Conclusion BMI, plasma glucose, TC, LDL-C and TG are risk factors of MBPS phenomenon, so weight loss, reducing plasma glucose and regulating blood fat should be paid attention to when controlling BP.