老年原发性高血压晨峰现象与靶器官损害临床研究  

Essential Hypertension with Morning Blood Pressure Surge and Target Organ Damage in Elderly

作　　者：王鑫[1] 郑霞[2] 朱艳利[1] 李文华[1] 

机构地区：[1]山东大学山东省立医院老年心血管科,山东济南250021 [2]山东省立医院保健心电图室,山东济南250021

出　　处：《医学与哲学（B）》2007年第4期28-30,共3页Medicine & Philosophy(B)

基　　金：山东省卫生厅基金资助;项目编号:2005-03

摘　　要：应用24h动态血压监测(ABPM)了解老年原发性高血压晨峰现象对主要靶器官结构及功能的潜在损害。114例老年原发性高血压患者根据24h动态血压监测分为晨峰组和非晨峰组,均常规检查血脂谱,空腹血糖,放免法测定尿微量白蛋白,计算体重指数(BMI)、左室质量指数(LVMI)、颈总动脉(CCA-IMT)和颈内动脉内膜中层厚度(ICA-IMT)、心电图测量计算QT离散度(QTcd)。晨峰组的24h、白昼、夜间平均收缩压均显著高于非晨峰组动态血压监测水平(P<0.05),而且晨峰组的睡-谷晨峰变异幅度增高有统计学意义(P<0.05)。晨峰组的LVMI、CCA-IMT、ICA-IMT、QTcd和尿微量白蛋白指标均高于非晨峰组(P<0.01)。两组在BMI、血脂谱、血糖差异无统计学意义。清晨高血压是老年原发性高血压病的一个不可忽视的潜在危险因素。长期晨间血压负荷升高使得机体全天处于血压高负荷状态,更易使心肌重构肥厚和心电生理特征改变,增加心律失常发生率;加速动脉粥样硬化斑块形成。因此遏制老年原发性高血压患者的晨峰高反应是降压达标和减缓靶器官损害的关键环节。To investigate the target organ damage that essential hypertension with morning blood pressure surge in elderly with using 24h ABPM profiles. 114 cases were divided into two groups, morning blood pressure surege group and morning blood pressure normal group , according to 24h arnbulatory blood pressure monitoring profiles, Cholesterol, microalbuminuria、 body mass index （BMI）,left ventficular mass index（LVMI）, carotis endarterium intercellular medium thickness （CCA- IMT and ICA- IMT） and QT dispersion（QTcd） 24h, day and night blood pressure in morning surge group are significantly higher than those of normal group （P〈0.05）. Morning systolic blood pressure variability in morning is significantly higher （ P〈0.05）. LVMI,CCA- IMT, ICA- IMT,QTcd and microalbuminuria in morning blood pressure surge group are higher significantly than those of morning blood pressur normal group（ P 〈 0.01 ）. There no difference between two groups in gender, age, BMI. Morning blood pressure surge is an important risk factor in elderly in hypertension,it causes damage to heart, kidney and blood vessel endothelium seriously, progressing ventricular hypertrophy and reconstitution, cardiac conduction arrhythrnia and blood vessel ruction transform under increasing morning blood pressure burden. So lowering the morning surge is a sensible way in hypertension management.

关 键 词：老年 晨峰 靶器官损害 动态血压监测 

分 类 号：R544.1[医药卫生—心血管疾病]