老年高血压患者长时血压变异性及降压治疗对动脉僵硬度的影响

Effect of long-term blood pressure variability and anti-hypertensive treatment on arterial stiffness in elderly hypertensive patients

目的探讨长时血压变异性(BPV)和降压治疗对动脉僵硬度的影响。方法选取2017年1月至6月于山西白求恩医院进行降压治疗及管理的原发性老年高血压患者411例,用臂踝脉搏波传导速度(baPWV)和踝臂指数(ABI)作为评估动脉僵硬度的指标。采用线性回归分析血压指数及BPV与baPWV、ABI的相关性,BPV用收缩压标准差(SBP_SD)表示。采用SPSS 26.0统计软件进行数据分析。采用t检验分析降压治疗的效果以及降压治疗对动脉僵硬度的影响。结果通过3年降压治疗,老年高血压患者平均SBP、DBP、PP、MAP均较治疗前出现明显下降,FPG、TC、TG也较前明显下降,HDL-C较前明显升高,差异均有统计学意义[(131.78±7.36)和(142.92±17.14)mmHg(1 mmHg=0.133 kPa),(80.22±6.31)和(81.49±10.01)mmHg,(51.57±7.81)和(61.43±14.06)mmHg,(97.41±5.57)和(101.97±10.98)mmHg,(5.30±1.67)和(5.81±1.69)mmol/L,(3.85±0.95)和(4.42±0.90)mmol/L,(1.27±0.68)和(1.79±1.13)mmol/L,(1.35±0.31)和(1.21±0.31)mmol/L;均P<0.05];而治疗前后LDL-C的差异无统计学意义。调整混杂因素后线性回归结果显示,在老年高血压患者中SBP、PP、MAP、SBP_SD均与baPWV呈正相关(β=10.390,5.500,14.940,11.110;均P<0.05),与ABI呈负相关(β=-0.002,-0.001,-0.002,-0.003;均P<0.05);而DBP仅与baPWV呈正相关(β=8.690,P<0.05),而与ABI无相关性。降压治疗后,baPWV由(1782.70±308.87)cm/s降至(1732.43±261.73)cm/s、ABI由(1.12±0.10)升至(1.14±0.08),差异均有统计学意义(均P<0.05);其中baPWV在性别和年龄分层分析中均表现出下降趋势,与降压治疗前相比,差异均有统计学意义(均P<0.05);而ABI在女性患者及60~70岁患者中,与降压治疗前相比,差异均有统计学意义(均P<0.05)。降压前后SBP差值、DBP差值与baPWV差值均呈正相关(β=3.000,3.290;P<0.05),而与ABI差值无相关性。结论SBP_SD是动脉僵硬度的影响因素,对老年高血压患者进行降压治疗及综合管理,可以显著改善患者的baPWV值,而降压治疗对ABI的影响尚需进一步的研究去明确。

Objective To explore the effect of long-term blood pressure variability and anti-hypertensive treatment on arterial stiffness.Methods A total of 411 elderly patients with essential hypertension who were treated and managed in our hospital from January to June 2017 were enrolled in this study.Brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)were used as indicators to evaluate arterial stiffness.Linear regression analysis was employed to analyze the correlations of blood pressure index and long-term blood pressure variability(BPV)with baPWV and ABI.BPV was expressed as systolic blood pressure standard deviation(SBP_SD).SPSS statistics 26.0 was applied for data analysis.The efficacy of anti-hypertensive therapy and the effect of antihypertensive therapy on arterial stiffness were analyzed by student′s t test.Results In those elderly patients with hypertension,3 years′anti-hypertensive treatment resulted in significantly decreased average systolic blood pressure[SBP,(131.78±7.36)vs(142.92±17.14)mmHg(1 mmHg=0.133 kPa)],diastolic blood pressure[DBP,(80.22±6.31)vs(81.49±10.01)mmHg],pulse pressure[PP,(51.57±7.81)vs(61.43±14.06)mmHg]and mean artery pressure[MAP,(97.41±5.57)vs(101.97±10.98)mmHg],obviously reduced fasting plasma glucose[FPG,(5.30±1.67)vs(5.81±1.69)mmol/L],total cholesterol[(3.85±0.95)vs(4.42±0.90)mmol/L]and triglyceride[(1.27±0.68)vs(1.79±1.13)mmol/L],but remarkably elevated high-density lipoprotein cholesterol[(1.35±0.31)vs(1.21±0.31)mmol/L]when compared the corresponding values before treatment(all P<0.05).No such statistical change was seen in low-density lipoprotein cholesterol level before and after treatment.After adjustment for confounding factors,SBP,PP,MAP and SBP_SD were positively correlated with baPWV(β=10.390,5.500,14.940,11.110,all P<0.05)and negatively with ABI(β=-0.002,-0.001,-0.002,-0.003,all P<0.05)in the patients.DBP was only positively correlated with baPWV(β=8.690,P<0.05),but had no correlation with ABI.After antihypertensive treatment,baPWV was decreased from(1782.70±308.87)cm/s to(1732.43±261.73)cm/s,and ABI was increased from(1.12±0.10)to(1.14±0.08),with statistically differences(both P<0.05).Among them,baPWV showed a downward trend in gender and age stratifications,and significant difference was seen compared with that before antihypertensive treatment(P<0.05).ABI in the female patients and those aged 60-70 years was significantly different from that before anti-hypertensive treatment(P<0.05).The SBP difference and DBP difference before and after treatment were positively correlated with the difference of baPWV(β=3.000,3.290,P<0.05),but not with the difference of ABI.Conclusion SBP_SD is an influencing factor of arterial stiffness.The antihypertensive treatment and comprehensive management of elderly hypertensive patients can significantly improve their baPWV value,but the effect on ABI needs further research to clarify.