高血压病患者动态血压变化与颅内动脉粥样硬化狭窄相关性的初步分析

Preliminary Analysis of Correlation between Ambulatory Blood Pressure and Presence of Intracranial Atherosclerotic Stenosis in Patients with Hypertension

目的探讨高血压病患者动态血压变化与颅内动脉粥样硬化狭窄(intracranial atherosclerotic stenosis,ICAS)的相关性。方法对高血压病患者进行动态血压监测和脑血管磁共振血管成像检查。颅内大动脉内径狭窄程度≥50%定义为ICAS。根据日间与夜间平均血压水平,将昼夜血压变化分为杓型、非杓型、反杓型。应用多因素Logistic回归分析方法探讨ICAS发生的危险因素。结果 2014-01~07月间,共168例高血压病患者进入本研究:ICAS患者49例,非ICAS患者119例;日间平均收缩压升高109例(64.9%),日间平均舒张压升高56例(33.3%),夜间平均收缩压升高143例(85.1%),夜间平均舒张压升高129例(76.8%);昼夜血压杓型21例(12.5%),非杓型87例(51.8%),反杓型60例(35.7%)。ICAS组与对照组的24 h、日间、夜间平均收缩压和平均舒张压,以及日间平均血压升高、夜间平均血压升高、昼夜血压杓型改变、非杓型改变、反杓型改变的发病率无显著差异(P>0.05)。但是,ICAS组患者的24 h、日间和夜间平均脉压显著高于对照组(P<0.01)。多因素Logistic回归分析提示24 h平均脉压、日间平均脉压和夜间平均脉压升高与ICAS的发生密切相关(P<0.05)。结论平均脉压升高可能是ICAS发生的独立危险因素。

Objective To investigate the correlation of ambulatory blood pressure and intracranial atherosclerotic stenosis(ICAS)in patients with hypertension.Methods The patients with hypertension aged≥40 years were enrolled in this study.All subjects underwent ambulatory blood pressure monitoring and magnetic resonance angiography of the intracranial vessels.The ICAS was defined as that the degree of diameter stenosis of intracranial large arteries were ≥50%.According to the daytime and nighttime mean blood pressure(BP)level,the circadian BP pattern was divided into three groups:dipper,non-dipper and inverse-dipper.Multivariable logistic regression analysis were used to detect the independent risk factors for presence of ICAS.Results From January 2014 to July 2014,a total of 168 patients with hypertension were enrolled in this study.Of all the 168 patients,49 patients classified as the ICAS group,119 patients as the control group.The daytime mean systolic BP increased in109 patients(64.9%),daytime mean diastolic BP increased in56patients(33.3%),nighttime mean systolic BP increased in 143 patients(85.1%),and nighttime mean diastolic BP increased in 129 patients(76.8%).The incidence of dipper,non-dipper and inverse-dipper pattern was 12.5%,51.8%,and 35.7%,respectively.No significant difference was found in 24-hour,day and night mean systolic or diastolic pressure levels and the incidence of increased daytime or nighttime mean BP,dipper,non-dipper and inverse-dipper pattern between the ICAS and control group(P>0.05).However,the 24-hour,day and night mean pulse pressure level in the ICAS group were significantly higher than that in control group(P<0.01).Multivariate logistic regression analysis showed that the increased 24-hour,daytime and nighttime mean pulse pressure were closely related with the presence of ICAS(P<0.05).Conclusion The increased mean pulse pressure may be an independent risk factor of ICAS.