动态脉压与老老年原发性高血压患者颈动脉内膜中膜厚度的相关性  

Ambulatory Pulse Pressure and Carotid Intima Media Thickness in Very Old Patients with Essential Hypertension

作　　者：石洁[1] 杜柏[1] 商秀洋[1] 胡元会[1] 史琦[1] 褚瑜光[1] 朱紫嫣[1] 

机构地区：[1]中国中医科学院广安门医院心内科,北京100053

出　　处：《中华高血压杂志》2009年第4期310-313,共4页Chinese Journal of Hypertension

摘　　要：目的探讨老老年原发性高血压(EH)患者动态脉压(APP)与颈动脉内膜中膜厚度(IMT)的相关性。方法收集82例年龄≥80岁(老老年)EH患者的临床资料,应用24h动态血压监测仪监测患者的APP水平,根据APP的平均值将患者分为两组:APP<60mmHg组(n=40)和APP≥60mmHg组(n=42),分别以彩色多普勒超声测定其颈动脉IMT,采集其静脉血测定血脂及其他代谢指标含量。结果APP≥60mmHg组IMT明显大于APP<60mmHg组[(0.19±0.06)比(0.15±0.03)cm,P<0.01];IMT与APP呈正相关(r=0.38,P<0.01)。APP≥60mmHg组的24h收缩压(SBP)、24h脉压(PP)及24h动态脉压指数(PPI)均大于APP<60mmHg组[24hSBP(138.1±11.8)比(119.0±10.2)mmHg,P<0.01;24hPP(72.8±8.9)比(54.9±6.2)mmHg,P<0.01;24hPPI(0.52±0.09)比(0.45±0.08),P<0.05]。两组患者的血脂及其他代谢指标水平、24hDBP(舒张压)水平均无显著差异(P>0.05)。多元逐步回归分析经校正血糖、血尿酸、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血压参数(24hSBP、24hDBP、24hPP)未能证明24hPPI与颈动脉IMT有关。结论APP大的老老年EH患者颈动脉IMT增加更明显,老老年EH患者颈动脉IMT增加的主要危险因素可能更主要的是"老龄化"所致。Objective To study the relationship between ambulatory pulse pressure （APP） and carotid intima media thickness（IMT） in the very old patients （≥80 years old） with essential hypertension（EH）. Methods Ac- cording to their APP measured with ambulatory blood pressure monitoring（ABPM）, eighty-two very old patients with EH were divided into two groups： APP〈60 mmHg group（n=40） and APP.60 mmHg group（n=42）. The carotid IMT were measured using B-mode Doppler ultrasonography. Blood lipid and gluco-lipid metabolic profiles were determined. Results IMT in APP≥60 mmHg group was significantly increased compared with that of APP 〈60 mmHg group [（0.19±0.06） vs （0.15±0.03）cm, P〈0.01]. IMT positively correlated with APP （r=0.38, P〈0.01）. Compared with APP%60 mmHg group, the 24 h SBP, 24 h PP and 24 h PPI of APP ≥60 mmHg group were significantly increased [24 h SBP （ 138.1 ± 11.8 ） vs （ 119.0 ± 10.2 ） mmHg, P%0.01 ; 24 hPP （72.8±8.9） vs （54. 9±6. 2）mmHg, P〈0.01; 24 hPPI（0.52±0.09） vs （0. 45±0.08）, P〈0.05]. The 24 h DBP, blood lipid and other gluco-lipid metabolic indexes had no significant difference（P〉0.05）between the two groups. After adjustment for serum glucose, lipid profiles and 24 h SBP, DBP, no association between APP and IMT in carotid artery was found. Conclusion Higher APP was associated with thicker of carotid intima media in the very old patients with EH. The higher the APP, the worse the carotid artery subclinical atherosclerosis.

关 键 词：原发性高血压 颈动脉硬化 动态脉压 老老年 

分 类 号：R544.1[医药卫生—心血管疾病]