高血压患者清晨高血压与颈动脉内中膜厚度增加及斑块形成的关系

Clinical Study of Increased intima-media thickness and plaque formation in Patients with Morning Hypertension

目的分析高血压患者清晨高血压(morning hypertension,MH)与颈动脉内中膜厚度(intima-media thickness,IMT)增加和颈动脉斑块(Carotid artery plaque,CAP)的关系。方法选取2020年1月至2021年12月泰州市人民医院门诊或住院的原发性高血压患者168例,根据24 h动态血压测量(ambulatory blood pressure measurement,ABPM)结果,分为MH组和对照组,比较两组IMT和CAP。结果41例患者存在MH,占24.4%。与对照组比较,MH组年龄大(54.2±13.4 vs 48.6±15.4,P=0.035),高血压病程较长[6(2,14)vs 3(1,6),P=0.028]。同时清晨血压,包括清晨6:00~10:00时间段的收缩压(systolic blood presume,SBP)(145.7±12.8 vs 132.0±11.6,P=0.005)、舒张压(diastolic blood presume,DBP)(84.8±11.5 vs 74.5±10.9,P=0.014)和醒后2小时的SBP(149.2±14.8 vs 134.6±12.5,P=0.013)、DBP(91.2±10.6 vs 79.2±8.5,P=0.000)均高于对照组,存在统计学差异。IMT厚度(1.38±0.46 vs 1.22±0.39,P=0.000)和CAP发生率[23(56.1)vs 39(30.7),P=0.003]明显高于对照组,有显著差异。结论原发性高血压病人存在MH现象,MH促进颈动脉粥样硬化和CAP形成。

Objective To analyze the relationship between morning hypertension(MH)and increased carotid artery intima-media thickness(IMT)and carotid artery plaque(CAP)in patients with hypertension.Methods From January 2020 to December 2021,168 patients with essential hypertension who were outpatients or hospitalized at the affiliated Taizhou People’s Hospital of Nanjing Medical University were selected and divided into MH and control groups based on the results of 24h ambulatory blood pressure measurement(ABPM).The IMT and CAP of the two groups were compared.The findings revealed that 41 patients(24.4%)had MH.Patients in MH group were older than those in the control group and had a longer period of hypertension.The morning blood pressure of patients in MH group,including systolic blood presume(SBP)and diastolic blood presume(DBP)in 6:00~10:00am were statistically higher than those in the control group.Furthermore,SBP and DBP at 2 hours after awakening were also higher than those in the control group.IMT thickness and CAP incidence were also significantly higher in the MH group than those in the control group.Conclusion MH is present in essential hypertension patients,which is correlated with the increased IMT and CAP formation.