高龄男性原发性高血压患者血压昼夜节律与动脉硬化程度的关系初探

Relationship between circadian blood pressure rhythm and atherosclerosis in very old male essential hypertension patients

目的探讨高龄男性原发性高血压患者血压昼夜节律与动脉硬化的关系。方法选择2019年1~12月南部战区总医院干部病房四科收治的高龄男性原发性高血压患者160例,年龄80~98岁。行24 h动态血压检测,根据血压昼夜节律分为超杓型组(夜间/昼间血压比值≤0.8)6例,杓型组(0.8<夜间/昼间血压比值≤0.9)24例,非杓型组(0.9<夜间/昼间血压比值≤1)83例,反杓型组(夜间/昼间血压比值>1)47例。行颈动脉超声检测,计算心踝指数、踝肱指数、每搏外周阻力和每搏外周阻力指数,比较各组一般临床资料及心踝指数、踝肱指数、每搏外周阻力、每搏外周阻力指数的差异。比较夜间/昼间血压与心踝指数、踝肱指数、每搏外周阻力、每搏外周阻力指数的相关性。结果各组颈动脉硬化积分、心踝指数、踝肱指数比较,差异有统计学意义(P<0.01)。各组每搏外周阻力、每搏外周阻力指数比较,差异无统计学意义(P>0.05)。夜间舒张压/昼间舒张压比值与颈动脉硬化积分、心踝指数、踝肱指数呈正相关(r=0.490,P=0.000;r=0.617,P=0.000;r=0.776,P=0.000);而夜间收缩压/昼间收缩压比值与心踝指数、踝肱指数呈正相关(r=0.247,P=0.002;r=0.208,P=0.010)。结论高龄男性原发性高血压患者夜间舒张压/昼间舒张压比值与动脉僵硬度显著相关;夜间收缩压/昼间收缩压比值与动脉僵硬度相关性较小。改善动脉僵硬程度可能有利于血压昼夜节律的恢复。

Objective To study the relationship between circadian blood pressure rhythm and atherosclerosis in very old male essential hypertension patients.Methods One hundred and sixty male essential hypertension patients aged 80-98 years admitted to our hospital from January 2019 to December 2019 were divided into super dipper hypertension group(n=6),dipper hypertension group(n=24),non-dipper hypertension group(n=83) and reverse dipper hypertension group(n=47) according to their circadian blood pressure rhythm during the 24 h ambulatory blood pressure monitoring.Their cardio-ankle vascular index(CAVI),ankle-brachial index(ABI),sphygmus systemic vascular resistance(SSVR),sphygmus systemic vascular resistance coefficient(SSVRC) were calculated by carotid artery ultrasonography.Their general clinical data, CAVI,ABI,SSVR and SSVRC were compared.The relationship of nocturnal/diurnal blood pressure ratio with CAVI,ABI,SSVR and SSVRC in very old male essential hypertension patients was analyzed.Results Significant difference was detected in carotid atherosclerosis score, CAVI and ABI(P<0.01) with no significant difference detected in SSVR and SSVRI among different dipper hypertension groups(P>0.05).The nocturnal/diurnal DBP ratio was positively related with the carotid atherosclerosis score, CAVI and ABI(r=0.490,P=0.000;r=0.617,P=0.000;r=0.776,P=0.000) while the nocturnal/diurnal SBP ratio was positively related with the CAVI and ABI(r=0.247,P=0.002;r=0.208,P=0.010).Conclusion Nocturnal/diurnal DBP ratio is closely related with arterial stiffness while nocturnal/diurnal SBP ratio is not related with arterial stiffness in very old male essential hypertension patients, and improving arterial stiffness can thus contribute to the recovery of their circadian blood pressure rhythm.