高血压患者夜间血压变化与颅内动脉粥样硬化狭窄的相关性

Association between nocturnal blood pressure and intracranial atherosclerotic stenosis in patients with hypertension

目的探讨高血压患者夜间血压变化与颅内动脉粥样硬化狭窄(ICAS)的相关性。方法对高血压患者进行动态血压监测和脑血管磁共振血管成像(MRA)检查。颅内大动脉内径狭窄程度≥50%定义为ICAS,ICAS病灶数≥2定义为多发性ICAS。根据日间与夜间平均血压水平,将昼夜血压变化分为杓型、非杓型、反杓型。结果共359例高血压患者进入本研究:ICAS患者135例,单发性ICAS 86例,多发性ICAS 49例;226例(63.0%)日间平均血压升高,322例(89.7%)夜间平均血压升高;杓型37例(10.3%),非杓型166例(46.2%),反杓型156例(43.5%)。多因素Logistic回归分析提示:日间平均血压升高、夜间平均血压升高、夜间血压非杓型改变、夜间血压反杓型改变均与ICAS无显著相关性(P>0.05);夜间血压反杓型改变与多发性ICAS密切相关(P<0.05)。结论夜间血压反杓型改变可能是多发性ICAS的独立危险因素。

Objective To investigate the relationship between changes of nocturnal blood pressure and presence of in tracranial atherosclerotic stenosis （ICAS） in patients with hypertension. Methods The patients with hypertensionc aged ≥ 40 years were enrolled in this study. All subjects underwent ambulatory blood pressure monitoring and magnetic resonance angiography （MRA） of the intracranial vessels. The 1CAS was defined as that diameter of the stenosed intracranial large arteries was over 50%. The multi-lesion ICAS was defined as that the number of ICAS lesions was ≥2. According to the daytime and nighttime mean blood pressure （BP） level, the circadian BP pattern was divided into three groups： dipper, non-dipper and in verse dipper. Results A total of 359 patients with hypertension were enrolled in this study. Of all the 359 patients, 135 patients were classified as the ICAS group, including 86 patients with single-lesion 1CAS and 49 patients with multi-lesion ICAS. The daytime mean BP increased in 226 patients （63%）, and nocturnal mean BP increased in 322 patients （89.7%）. The incidence of dipper, non-dipper and inverse-dipper pattern was 10.3%, 46.2% and 43.5%, respectively. Multivariate Logistic regression analysis showed that the elevated nocturnal mean BP, non-dipper and inverse-dipper pattern were not significantly correlated with the presence of ICAS （P〉0.05）. However, inverse-dipper pattern was significantly associated with presence of multi-lesion ICAS （P〈0.05）. Conclusion This study suggests that the inverse-dipper pattern may be an independent risk factor for the presence of multiple lesion ICAS.