老年H型高血压患者364例动态血压变异性及动脉硬化特点

Analysis of blood pressure variability and cardio-ankle vascular index in elderly patients with H-type hypertension

目的观察老年H型高血压患者的动态血压变异性、血压昼夜节律及动脉硬化特点。方法选择广州军区广州总医院体检离退休老年男性原发性高血压患者364例,分别进行血浆同型半胱氨酸(Hcy)水平测定和动态血压、心-踝血管指数(CAVI)测定,根据Hcy水平分为H型高血压组和非H型高血压组。分析比较两组间的血压变异性、动脉硬化特点。结果与非H型高血压组相比,H型高血压患者动态血压表现为非杓型和反杓型明显增多。H型高血压组患者24h平均收缩压标准差、日间收缩压标准差、日间舒张压标准差、夜间收缩压标准差、24h收缩压加权标准差、24h舒张压加权标准差明显增高,差异有统计学意义(均P<0.05)。H型高血压组患者两侧CAVI与非H型高血压组相比均明显升高,差异有统计学意义(均P<0.05)。多元线性回归分析显示年龄、收缩压、Hb A1C、体质指数及Hcy是CAVI的独立影响因素(β=0.231、0.132、0.123、-0.157、0.096,均P<0.05)。结论老年H型高血压患者血压变异性增高及昼夜节律减弱,动脉僵硬度增大,年龄、收缩压、Hb A1C、体质指数及Hcy等心脑血管病危险因素对CAVI具有显著影响。

Objective To observe the characteristics of blood pressure variability and cardio-ankle vascular index(CAVI) in elderly patients with H-type hypertension.Methods We included 364 elderly male patients with essential hypertension,on whom the detection of plasma homocysteine(Hcy),ambulatory blood pressure monitoring and CAVI measurement were given.The patients were divided,according to Hcy level,into H-type hypertension group(n =189) and non-H-type hypertension group(n = 175).The characteristics of blood pressure variability and CAVI were compared and analyzed between the two groups.Results The blood pressure variability in H-type hypertension group was significantly higher than that in non-H-type hypertension group,with significantly higher 24h SSD,d SSD,d DSD,n SSD and 24h Sw SD(P < 0.05); The bilateral CAVIs in H-type hypertensive patients were significantly higher than those in non-H-type hypertension group(P < 0.05).Multivariate analysis showed that age,SBP,Hb A1C,BMI and Hcy were independent related factors of CAVI in all subjects(β = 0.231,0.132,0.123,-0.157,and 0.096,P <0.05).Conclusion The blood pressure variability and CAVI are higher in the elderly patients with H-type hypertension than those in non-H-type hypertension.Age,SBP,Hb A1C,BMI and Hcy are positively correlated with CAVI.