不同肾功能水平老老年高血压患者血压特点初探

Preliminary Study on Blood Pressure Characteristics of Very Elderly Hypertension Patients at Different Levels of Renal Function

目的:探讨不同肾功能水平老老年高血压患者血压特点。方法:选取2013年11月~2014年07月于广安门医院心内科住院的原发性高血压患者322例,比较不同肾功能水平(CKD3~5期、1~2期)的非老老年(<80岁)及老老年(≥80岁)患者24 h动态血压参数。结果:(1)非老老年组175例,老老年组147例,与非老老年组相比,老老年组年龄、SBP、Cr、HDL-C升高,BMI、DBP、e GFR、TG降低,差异有统计学意义(P<0.05,P<0.01)。(2)在总人群中,老老年组24 h SBP、d SBP、SD 24 h SBP、SD d SBP升高,而24 h DBP、n DBP则降低,差异有统计学意义(P<0.05,P<0.01)。在CKD1~2期患者中,老老年组24 h SBP、d SBP、SD 24 h SBP、SD d SBP升高,而24 h DBP、n DBP、SD n DBP则降低,差异有统计学意义(P<0.05,P<0.01)。但在CKD3~5期患者中,两组患者平均血压及血压变异性参数差异均无统计学意义(P>0.05)。结论:老老年高血压患者SBP升高而DBP下降,脉压及血压变异性增大。其原因可能为自主神经功能受损及动脉僵硬程度增加。CKD3~5期老老年患者在平均血压及血压变异性方面与非老老年患者无差异,可能与肾功能损伤、合并用药有关,具体影响因素仍有待进一步研究。

Objective:To explore the blood pressure characteristics of very elderly hypertension patients at different levels of renal function.Methods:322 very elderly patients with primary hypertension admitted to the cardiology department,Guang’anmen Hospital from November 2013 to July 2014 were selected.The differences of 24-hour ambulatory blood pressure parameters between very elderly and non-very elderly patients at different levels of renal function were compared.Results:Compared to non-very elderly group,the age,SBP,Cr and HDL-C in very elderly group increased,and BMI,DBP,e GFR,TG decreased,the differences were statistically significant(P<0.05,P<0.01).In the general population,24 h SBP,d SBP,SD 24 h SBP,SD d SBP raised significantly in very elderly group,while 24 h DBP and n DBP significantly declined(P<0.05,P<0.01).In CKD stage 1~2 patients,24 h SBP,d SBP,SD 24 h SBP and SD d SBP elevated in very elderly group,but 24 h DBP,n DBP and SD n DBP significantly reduced(P<0.05,P<0.01).However,in CKD stage 3~5 patients,there was no significant difference(P>0.05).Conclusion:Very elderly patients with hypertension showed high SBP and low DBP,the pulse pressure and BPV increased.It might be attributed to impaired autonomic nerve function and increased arterial stiffness.When accompanied with CKD,there was no difference between very elderly and non-very elderly patients in MBP and BPV,which may be related to renal function damage and combined medication.The influencing factors remain to be further studied.