青年与老年难治性高血压患者动态血压特点与差异研究

Study on characteristics of ambulatory blood pressure in young and elderly patients with refractory hypertension

目的探讨青年与老年难治性高血压（RH）患者动态血压的特点和差异。方法连续收集2010年1月至2015年8月首都医科大学附属北京安贞医院高血压科住院青年与老年RH患者228例的病历资料，根据年龄分为青年组（140例，18-40岁）和老年组（88例，≥70岁）；以性别、年龄匹配的同一时间段住院的非RH青年高血压患者140例为对照组。比较青年组与老年组及对照组的动态血压指标。结果青年组24h平均舒张压、24h平均动脉压、白昼平均舒张压、夜间平均舒张压、24h心率、白昼平均心率、夜间平均心率均高于老年组[（91±9）mmHg（1mmHg=0．133kPa）比（70±9）mmHg、（107±10）mmHg比（94±7）mmHg、（93±10）mmHg比（71±9）mmHg、（87±11）mmHg比（67±10）mmHg、（72±9）次／min比（65±7）次／min、（75±10）次／min比（67±7）次／min、（65±10）次／min比（61±7）次／min]，24h平均脉压低于老年组[（49±9）mmHg比（68±11）mmHg]，差异均有统计学意义（均P〈0．05）。青年组24h平均收缩压、24h平均舒张压、24h平均动脉压、白昼平均收缩压、白昼平均舒张压、夜间平均收缩压、夜间平均舒张压、24h平均脉压、夜间平均心率均高于对照组[（140±13）mmHg比（128±9）mmHg、（91±9）mmHg比（84±7）mmHg、（107±10）mmHg比（97±8）mmHg、（142±13）mmHg比（131±9）mmHg、（93±10）mmHg比（87±7）mmHg、（135±15）mmHg比（121±10）mmHg、（87±11）mmHg比（79±8）mmHg、（49±9）mmHg比（44±6）mmHg、（65±10）次／min比（63±7）次／min]，夜间血压下降率低于对照组[（5±8）％比（8±7）％]，差异均有统计学意义（均P〈0．05）。结论青年与老年RH患者均存在夜间血压下降率减少；青年RH患者舒张压高于老年RH患者，夜间心率增加明显。青年RH患者降压治疗可优先选用β受体阻滞剂。

Objective To explore the characteristics of ambulatory blood pressure in young and elderly with refractory hypertension. Methods Totally 228 patients with refractory hypertension were continuously enrolled from January 2010 to August 2015 in Beijing Anzhen Hospital, Capital Medical University. The patients were divided into young group （18-40 years old, 140 cases ） and elderly group （≥ 70 years old, 88 cases）; 140 young patients with non-refractory hypertension were enrolled as control group. Ambulatory blood pressure indexes were analyzed among 3 groups. Results The 24 h diastolic blood pressure, 24 h arterial pressure, daytime diastolic blood pressure, nighttime diastolic blood pressure, 24 h heart rate, daytime heart rate, nighttime heart rate in young group were higher than those in elderly group [ （ 91 ± 9 ） mmHg vs （ 70 ± 9 ） mmHg, （ 107 ± 10） mmHg vs （94 ± 7 ） mmHg, （93 ± 10） mmHg vs （71 ± 9 ） mmHg, （ 87 ± 11 ） mmHg vs （ 67 ± 10） mmHg, （ 72 ± 9 ） times/rain vs （65 ±7 ） times/min, （ 75 ± 10） times/min vs （ 67 ± 7 ） times/min, （ 65 ± 10 ） times/min vs （ 61 ± 7 ）times/min ] ; the 24 h pulse pressure in young group was lower than those in elderly group [ （49 ± 9）mmHg vs （ 68 ± 11 ） mmHg] ; the differences were statistically significant（ P 〈 0. 05 ）. The 24 h systolic blood pressure, 24 h diastolic blood pressure, 24 h arterial pressure, daytime systolic blood pressure, daytime diastolic blood pressure,nighttime systolic blood pressure, noetural diastolic blood pressure, 24 h pulse pressure, nighttime heart rate in young group were higher than those in control group [ （ 140 ± 13 ） mmHg vs （ 128 ± 9 ） mmHg, （ 91 ± 9 ） mmHg vs （ 84 ± 7 ） mmHg, （ 107 ± 10 ） mmHg vs （97 ± 8 ） mmHg, （ 142 ± 13 ） mmHg vs （ 131 - 9 ） mmHg, （ 93 ±10 ） mmHg vs （ 87 ± 7 ） mmHg, （ 135 ± 15 ） mmHg vs （ 121 ± 10 ） mmHg, （ 87 ± 11 ） mmHg vs （79 ± 8 ） mmHg, （49 ± 9 ） mmHg vs （44 ± 6 ）mmHg, （65 ± 10 ）times/rain vs （63±7 ）times/min ] ; the nighttime blood pressure decline rate in young group was lower than that in control group [ （5±8 ）% vs （8 ± 7 ）%] ; the differences were statistically significant （P 〈 0.05 ）. Conclusions Blood pressure decreases during nighttime in both young and elderly patients with refractory hypertension. Young patients have higher diastolic blood pressure and nighttime heart rate compared to elderly patients.