老年单纯收缩期高血压患者血压昼夜节律异常与晨峰现象对动脉僵硬度的影响

Influence of abnormal blood pressure circadian rhythms and the morning surge on aortic stiffness in the elderly patients with isolated systolic hypertension

目的探讨老年单纯收缩期高血压(ISH)患者血压昼夜节律异常与晨峰现象对动脉僵硬度的影响。方法回顾性分析,入选年龄≥60岁未接受治疗的老年ISH患者300例,采用无创便携袖带式动态血压计检测24 h动态血压,全自动动脉硬化检测仪检测脉搏波传导速度(baPWV)和踝臂指数(ABI),按夜间血压下降率分为杓型组95例、非杓型组177例和超杓型组28例,按血压晨峰值分为晨峰组88例和非晨峰组212例,比较各组间基线资料、血压昼夜节律、动脉硬化指标。采用偏相关和多元线性回归分析,分析各参数对baPWV和ABI的影响。结果杓型组、非杓型组和超杓型组患者baPWV呈递增趋势,分别为(1402±234)cm/s、(1467±114)cm/s和(1538±140)cm/s(P<0.01);ABI超杓型组(0.98±0.10)较杓型组(1.05±0.12)降低(P<0.01),较非杓型组(1.03±0.12)亦降低(P<0.05),而杓型组和非杓型组间比较差异无统计学意义(P>0.05)。晨峰组较非晨峰组患者baPWV[(1508±170)cm/s比(1430±163)cm/s]升高(P<0.01);晨峰组较非晨峰组患者ABI降低(0.98±0.13比1.06±0.11,P<0.01)。baPWV与日间平均收缩压(r=0.169,P<0.01)、24 h收缩压变异系数(r=0.143,P<0.05)、血压晨峰现象(r=0.157,P<0.01)呈正相关;而ABI与日间平均收缩压(r=-0.146,P<0.05)、血压晨峰现象(r=-0.321,P<0.01)呈负相关。年龄(P<0.01)、日间平均收缩压(P<0.05)和24 h收缩压变异系数(P<0.05)是baPWV的独立影响因素;日间平均收缩压和晨峰血压是ABI的独立影响因素(均P<0.01)。结论老年ISH患者昼夜节律异常和晨峰高血压与动脉僵硬度增加相关。

Objective To investigate the influence of abnormal blood pressure circadian rhythms and the morning surge on aortic stiffness in elderly patients with isolated systolic hypertension(ISH).Methods A total of 300 untreated elderly(≥60 years)patients with ISH were enrolled.24-hour ambulatory blood pressure was measured by using a non-invasive portable ambulatory sphygmomanometer with an inflatable cuff.Brachial-ankle pulse wave velocity(baPWV)and the ankle-brachial pressure index(ABI)were measured by using an automated device.Patients were divided into the dipper(n=95),no-dipper(n=177)and extreme dipper(n=28)groups according to the rate of nocturnal blood pressure reduction.They were also divided into the morning surge(n=88)and no morning surge(n=212)groups according to the morning blood pressure surge(MBPS).Differences between the groups were compared.Correlations between the parameters were calculated by partial correlation analyses.The effects on baPWV and ABI were calculated by multiple linear regression analyses.Results baPWV was higher in the extreme dipper group than in the dipper and no dipper groups[(1402±234)cm/s vs.(1467±114)cm/s vs.(1538±140)cm/s,P<0.01],while ABI values were lower in the extreme dipper group than in the dipper group(0.98±0.10 vs.1.05±0.12,P<0.01)and the no dipper group(0.98±0.10 vs.1.03±0.12,P<0.05).Moreover,baPWV[(1508±170)cm/s vs.(1430±163)cm/s,P<0.01]was higher while ABI values(0.98±0.13 vs.1.06±0.11,P<0.01)were lower in the morning surge group than in the no morning surge group.baPWV was positively correlated with daytime Systolic blood pressure(dSBP)(r=0.169,P<0.01),24 hSBPCV(r=0.143,P<0.05),and MBPS(r=0.157,P<0.01),while ABI was negatively correlated with dSBP(r=-0.146,P=0.011)and MBPS(r=-0.321,P<0.01).Age(P<0.01),dSBP(P<0.05)and 24 h systolic blood pressure variation coefficient(P<0.05)were independent factors for baPWV,while dSBP and MBPS were independent factors for ABI(all P<0.01).Conclusions Abnormal blood pressure circadian rhythms and the morning surge are associated with increased aortic stiffness in elderly patients with ISH.