老年高血压患者24小时收缩压变化与肾功能的关系研究

Relationship between 24 h SBP variability and renal function in elderly hypertension patients

目的探讨老年高血压患者通过抗高血压治疗,其血压控制在正常范围后收缩压变化与肾功能的关系。方法选择老年男性原发性高血压患者436例,根据年龄分为老年组194例(65～80岁),高龄组242例(81～101岁)。又根据估算的肾小球滤过率(e GFR)分为e GFR 1组203例[e GFR> 89 ml/(min·1. 73 m2)],e GFR 2组129例[60～89 ml/(min·1. 73 m2)],e GFR 3组104例[<60 ml/(min·1. 73 m2)]。采用多元线性回归分析e GFR与血压控制不良的关系。结果老年组TC、LDL-C、e GFR、24 h舒张压、24 h舒张压负荷、夜间收缩压减少和夜间舒张压减少明显高于高龄组,年龄、糖尿病、冠心病、尿酸、夜间收缩压、24 h收缩压负荷明显低于高龄组(P <0. 05,P <0. 01)。与e GFR 1组比较,e GFR 2组和e GFR 3组昼间收缩压、夜间收缩压、24 h收缩压变异性明显增加,夜间收缩压减少和夜间舒张压减少明显降低(P <0. 05);与e GFR 1组比较,e GFR 3组24 h收缩压负荷明显增加[(39. 66±25. 79) mm Hg vs (34. 79±26. 18) mm Hg,1 mm Hg=0. 133 k Pa,P <0. 01]。多元线性回归分析显示,调整潜在的混杂因素后,24 h收缩压变异性和尿酸与e GFR相关(P <0. 01)。结论在24 h动态血压监测的参数中,24 h收缩压变异性是老年高血压患者肾功能下降的惟一独立危险因素。

Objective To study the relationship between 24 h SBP variability and renal function in elderly hypertension patients.Methods Four hundred and thirty-six elderly male essential hypertension patients were divided into 65-80 years old group(n=194),81-101 years old group(n=242)and into eGFR 1 group(n=203),eGFR 2 group(n=129)and eGFR 3 group(n=104).The relationship between eGFR and poor blood pressure control was analyzed by multivariate linear regression analysis.Results The serum TC and LDL-C levels,eGFR,24 h DBP,24 h DBP and night SBP were significantly higher while the age,incidence of DM and CHD,serum UA level,night SBP and 24 h SBP were significantly lower in 65-80 years old group than in 81-101 years old group(P<0.05,P<0.01).The 24 h SBP was significantly higher in eGFR 3 group than in eGFR 1 group(39.66±25.79 mm Hg vs 34.79±26.18 mm Hg,P<0.01).Multivariate linear regression analysis showed that the 24 SBP variability and uric acid was related with the eGFR after adjustment for potential confounders(P<0.01).Conclusion The 24 h SBP variability is an independent risk factor for decreased renal function in elderly hypertension patients.