老年高血压中医证型与血压变异性关系初探

Exploration on the Relationship Between Blood Pressure Variability and TCM Patterns of Senile Hypertension

目的:探讨老年高血压中医辨证分型与血压变异性的关系。方法:将老年高血压患者200例依据临床证候分为肝火亢盛、阴虚阳亢、阴阳两虚和痰湿壅盛4组,并进行24 h动态血压监测,将血压昼夜节律分为杓形、非杓形、深杓形和反杓形4级,观察动态血压水平,计算出夜间血压下降率,以此判断血压变异性。结果:肝火亢盛组呈明显昼高夜低,阴虚阳亢组呈夜高昼低,阴阳两虚组和痰湿壅盛组的昼夜节律不明显,同时阴阳两虚组收缩压升高明显,痰湿壅盛组舒张压升高明显,非杓型患者易出现阴虚阳亢证和阴阳两虚证。结论:老年高血压患者血压昼夜节律在中医辨证分型各组分布中存在差异。中医辨证分型能够协助判断靶器官损害及预后,对改善血压昼夜节律有潜在价值;动态血压作为高血压的重要检测手段,可为高血压中医辨证提供客观化参考。

Objective： To explore the relationship between TCM patterns of senile hypertension and blood pressure variability. Methods： Two hundred patients were classified into four groups： liver fire hyperactivity, Yin-deficiency and Yang-hyperactivity, dual deficiency of Yin-Yang,phlegm-dampness accumulation, and they accepted 24 hours ambulatory blood pressure monitoring, circadian rhythms of blood pressure were classified into four types： scoop-shaped, non-scoop shaped, deep scoopshaped and anti scoop-shaped, to observe the level of ambulatory blood pressure, calculate blood pressure decrease rate at night, therefore to judge blood pressure variability. Results： The rhythms of blood pressure in liver fire hyperactivity group showed high blood pressure at day and low at night obviously, they demonstrated high at night and low at day in Yin-deficiency and Yang-hyperactivity group, they were not apparent in the groups of dual deficiency of Yin-Yang and phlegm-dampness accumulation, simultaneously, systolic pressure in dual deficiency of Yin-Yang group raised significantly, diastolic pressure in phlegm-dampness accumu- lation group raised obviously, the patients with blood pressure of non scoop wedge rhythms were easily of Yin-deficiency and Yang-hyperactivity and dual deficiency of Yin-Yang. Conclusion： There are differences existed in the distributions of circadian rhythms in senile patients with hypertension of different patterns. Syndrome differentiation assists in judging the damage and the prognosis of target-organ, it possesses potential values in improving circadian rhythms of blood pressure; ambulatory blood pressure, as an important detection measures, could provide objective reference for syndrome differentiation of blood pressure.