老年高血压患者认知功能损害与血压变异性、昼夜动脉血压情况、脉压指数的相关性

Correlation between blood pressure variability,circadian arterial blood pressure,pulse pressure index and cognitive impairment in elderly patients with hypertension

目的探讨老年高血压患者认知功能损害与血压变异性、昼夜动脉血压情况、脉压指数的相关性。方法选取老年高血压患者200例,对所有患者进行简易智力状态检查量表(MMSE)检查,根据评分结果分为对照组(认知功能正常)80例与观察组(认知功能受损)120例。分析老年高血压患者的动态血压参数、昼夜血压节律性变化、脉压指数(PPI)、左室质量指数(LVMI)、血清胱抑素C(Cys C)以及踝肱指数对认知功能的影响。结果2组患者性别、年龄、病程、体质量指数(BMI)、心率(HR)等一般资料比较,差异无统计学意义(P>0.05)。对照组MMSE评分为(28.23±1.14)分,显著高于观察组的(22.23±3.14)分(P<0.05)。观察组平均收缩压(SBP)、白昼平均收缩压(DSBP)、夜间平均收缩压(NSBP)、脉压(PP)、PPI指标显著高于对照组(P<0.05);2组患者平均舒张压(DBP)、白昼平均舒张压(DDBP)、夜间平均舒张压(NDBP)比较,差异无统计学意义(P>0.05)。观察组昼夜节律比为(10.31±4.19)%,颈动脉内膜中层厚度(IMT)为(0.85±0.34)mm,与对照组的昼夜节律比(16.73±3.85)%及IMT(0.67±0.21)mm比较,差异有统计学意义(P<0.05)。对照组与观察组杓型、非杓型患者比例比较,差异有统计学意义(P<0.05)。观察组LVMI、Cys C高于对照组,踝肱指数低于对照组,差异有统计学意义(P<0.05)。相关性分析结果显示,MMSE评分与SBP、DSBP、NSBP、PP、PPI呈显著负相关(r=-0.925、-0.867、-0.914、-0.867、-0.927,P<0.05或P<0.01),与DBP、DDBP、NDBP无显著相关性(P>0.05)。结论老年高血压患者的认知功能受昼夜动脉血压情况、LVMI、血清Cys C、脉压指数以及踝肱指数等因素影响。针对老年高血压患者,应采取积极有效的措施控制血压及脉压指数,防止血压昼夜节律异常,逆转动脉粥样硬化,从而延缓认知功能损害的发生、发展。

Objective To investigate the correlation between blood pressure variability,circadian arterial blood pressure,pulse pressure index and cognitive impairment in elderly patients with hypertension.Methods Totally 200 elderly patients with hypertension were selected and conducted with simple Mental State Scale for Examination(MMSE).According to the scores,all the patients were divided into control group(n=80,with normal cognitive function)and observation group(n=120,with impaired cognitive function).The effects of ambulatory blood pressure parameters,circadian blood pressure rhythm,pulse pressure index(PPI),left ventricular mass index(LVMI),serum cystatin C(Cys C)and ankle brachial index on cognitive function in elderly patients with hypertension were analyzed.Results There were no significant differences in gender,age,course of disease,body mass index(BMI)and heart rate(HR)between two groups(P>0.05).The score of MMSE was(28.23±1.14)point in the control group,which was significantly higher than(22.23±3.14)point in the observation group(P<0.05).The indexes of systolic pressure(SBP),daytime systolic blood pressure(DSBP),nocturnal systolic blood pressure(NSBP),PP(pulse pressure)and PPI in the observation group were significantly higher than those in the control group(P<0.05).There were no significant differences in diastolic pressure(DBP),daytime diastolic pressure(DDBP)and nocturnal diastolic pressure(NDBP)between the two groups(P>0.05).In the observation group,the circadian rhythm ratio was(10.31±4.19)%and carotid intima media thickness(IMT)was(0.85±0.34)mm,which showed significant differences when compared to(16.73±3.85)%and(0.67±0.21)mm in the control group(P<0.05).There were significant differences in ratios of patients with dipper type and non dipper type between the two groups(P<0.05).LVMI and Cys C of the observation group were significantly higher than those of the control group,while the ankle brachial index was significantly lower than the control group(P<0.05).The results of correlation analysis showed that MMSE score was negatively correlated with SBP,DSBP,NSBP,PP and PPI(r=-0.925,-0.867,-0.914,-0.867,-0.927,P<0.05 or P<0.01),but showed no significant correlation with DBP,DDBP and NDBP(P>0.05).Conclusions The cognitive function of elderly patients with hypertension is affected by the circadian arterial blood pressure,LVMI,serum Cys C,pulse pressure index and ankle brachial index.For the elderly patients with hypertension,we should take active and effective measures to control blood pressure and pulse pressure index,prevent abnormal circadian rhythm of blood pressure and reverse atherosclerosis so as to delay the occurrence and development of cognitive impairment.