老年H型高血压患者血压变异性的临床研究

Clinical study of blood pressure variability in aged patients with H type hypertension

目的:探讨老年H型高血压患者血压变异性(BPV)的特点及影响因素。方法:选择2012年12月至2013年12月我院就诊的原发性高血压患者100例。根据血清同型半胱氨酸(Hcy)水平,患者被分为单纯高血压组(42例,Hcy<15.4μmol/L)和H型高血压组(58例,Hcy≥15.4μmol/L)。所有患者均接受24h动态血压监测(24hABPM),记录比较两组的BPV指标。分析BPV指标与一般资料的相关性,采用多元线性回归分析BPV指标的影响因素。结果:与单纯高血压组比较,H型高血压组24h收缩压标准差[24hSSD,(12.80±2.23)比(16.01±3.11)]、白天收缩压标准差[dSSD,(11.58±2.30)比(13.86±2.26)]和夜间收缩压标准差[nSSD,(9.41±1.64)比(11.71±2.34)]均显著增大,P<0.05或<0.01;Pearson相关分析显示,Hcy、总胆固醇(TC)和低密度脂蛋白-胆固醇(LDL-C)与24hSSD、dSSD和nSSD呈显著正相关(r=0.201~0.508,P<0.05或<0.01)。多元线性回归分析显示Hcy和TC与24hSSD、dSSD和nSSD呈显著正相关(B=0.194~0.546,P<0.05或<0.01)。结论:老年H型高血压患者的收缩压变异性显著高于单纯高血压患者。血清高同型半胱氨酸水平、总胆固醇水平升高与老年高血压患者收缩压变异性呈显著正相关,且是这类患者血压变异性的主要影响因素。

Objective： To explore characteristics and influencing factors for blood pressure variability （BPV） in aged patients with H type hypertension. Methods： A total of 100 patients with essential hypertension, who were treated in our hospital from Dec 2012 to Dec 2013, were selected. According to serum level of homocysteine （Hcy）, patients were divided into pure hypertension group （n = 42, Hcy〈15.4 μmol/L） and H type hypertension group （n = 58, Hcy≥15.4 μmol/L）. All patients received 24h ambulatory blood pressure monitoring （24hABPM）, and BPV indexes were recorded and compared between two groups. Correlation among BPV indexes and general data were analyzed, and multi-factor linear regression analysis was used to analyze influencing factors for BPV indexes. Results. Compared with pure hypertension group, there were significant rise in 24h systolic blood pressure standard deviation F24hSSD, （12.80 ± 2.23） vs. （16. 01 ± 3.11）], daytime SSD FdSSD, （11.58 ± 2.30） vs. （13.86 ± 2.26）] and nighttime SSD EnSSD, （9.41 ± 1.64） vs. （11.71 ± 2.34）] in H type hypertension group, P〈0.05 or 〈0.01. Pearson correlation analysis indicated that Hcy, total cholesterol （TC） and low density lipoprotein cholesterol （LDL-C） were significantly positively correlated with 24SSD, dSSD and nSSD （r = 0. 201-0. 508, P〈0.05 or 〈0.01）. Multivari- ate linear regression analysis indicated that Hcy and TC were significantly positively correlated with 24SSD, dSSD and nSSD （B= 0. 194-0. 546, P〈0.05 or -〈0.01）. Conclusion： Systolic blood pressure variability in aged patients with H type hypertension is significantly higher than that of patients with pure hypertension, their serum Hey level, TC elevating level are significantly positively correlated with systolic blood pressure variability and are major influencing factors for BPV in these patients.