高血压患者脉压与早期动脉粥样硬化指标的关系

The correlation between pulse pressure and early arteriosclerosis index in patients with hypertension

目的探讨高血压患者外周脉压,包括诊室脉压、24h平均脉压(24h MPP)和中心动脉脉压(CAPP)与早期动脉粥样硬化指标的关系。方法收集遵义医科大学附属医院高血压门诊未经治疗的高血压患者412例的临床资料,测量诊室脉压、24h MPP、CAPP,测定踝肱指数(ABI)、肱踝脉搏波传导速度(baPWV)、颈股脉搏波传导速度(cfPWV)、反射波增强指数(Alx)。结果高血压患者中诊室脉压、24h MPP和CAPP中男性宽脉压者分别占37.4%、41.2%、20.6%,女性分别占62.6%、58.8%、79.4%,不同性别间比较差异有统计学意义(P<0.05)。诊室脉压、24h MPP、CAPP均随年龄增大而增大,老年组脉压增大更明显(P<0.05)。与非宽脉压组比较,诊室脉压、24h MPP、CAPP宽脉压组ABI、Alx、baPWV、cfPWV均明显增高(P<0.05)。偏相关分析显示,诊室脉压、24h MPP、CAPP与baPWV、cfPWV均呈正相关,且诊室脉压、24h MPP与ABI,CAPP与Alx亦呈正相关,余无相关性。Bland-Altman分析显示,与诊室血压、脉压比较,24h平均血压、24h MPP与中心动脉血压和CAPP的一致性较好,其相关性亦较高。结论高血压患者脉压随年龄增大而增大,女性的脉压变化较男性更明显;脉压与ABI、baPWV、Alx、cfPWV均呈正相关,且诊室脉压与baPWV、24h MPP与baPWV、CAPP与Alx的相关性较高。24h MPP与CAPP的一致性和相关性均较诊室脉压高。

Objective To explore the correlation of the peripheral pulse pressures,including office pulse pressure and 24 h mean pulse pressure (24 h MPP),and the central artery pulse pressure (CAPP) and early indicators of arterial stiffness in patients with hypertension. Methods Clinical data were collected from 412 hypertensive patients (previously untreated).Office pulse pressure,24 h MPP,CAPP,ankle-brachial index(ABI),brachial-ankle pulse wave velocity (baPWV),augmentation index (Alx),carotid-femoral artery pulse wave velocity (cfPWV) were measured. Results Among the hypertensive patients,males accounted for 37.4%,41.2% and 20.6%,and females accounted for 62.6%,58.8% and 79.4%,of the patients with wide office pulse pressure,wide 24 h MPP and wide CAPP,respectively ( P <0.05).Pulse pressure was increased with age in patients with hypertension.Compared with those of the non-wide pulse pressure groups,ABI,baPWV,Alx and cfPWV were greater in the corresponding wide pulse pressure groups.Partial correlation analyses showed that office pulse pressure,24 h MPP and CAPP were positively correlated with baPWV and cfPWV,and office pulse pressure and 24 h MPP positively correlated with ABI,CAPP and Alx.Bland-Altman analysis showed that compared with office blood pressures and pulse pressure,24 h mean blood pressures and pulse pressure presented higher consistency and correlation with central artery blood pressures and CAPP. Conclusions Pulse pressure increases with age in patients with hypertension,with greater increases in pulse pressures in older females.Pulse pressures are positively correlated with ABI,baPWV,Alx and cfPWV,and there is higher correlation between office pulse pressure and baPWV,24 h MPP and baPWV,and between CAPP and Alx.24 h MPP and CAPP have higher consistency and correlation compared with office pulse pressure.