老年男性高血压患者血压变异性与肾功能的相关性分析  

Correlation between blood pressure variability and renal function in elderly male hypertensive patients

作　　者：王凡[1] 刘源[1] 朱启伟[1] 郑瑾[1] 盛莉[1] 杨旭[1] 肖铁卉[1] 叶平[1] 

机构地区：[1]解放军总医院南楼心血管二科,北京100853

出　　处：《中华老年心脑血管病杂志》2013年第3期228-231,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的了解血压控制良好的老年及高龄老年男性高血压患者血压变异性与肾功能的相关性。方法选择老年男性高血压患者413例,根据年龄分为老年组196例(年龄<80岁)和高龄组217例(年龄≥80岁)。给予24h动态血压监测及血液指标检测。血压变异性指标用24h收缩压和舒张压血压标准差表示,肾功能指标由估算的肾小球滤过率(eGFR)表示。将研究人群按照eGFR≥90ml/(min.1.73m2)、60～89ml/(min.1.73m2)、<60ml/(min.1.73m2)分为eGFR 1组89例、eGFR 2组179例和eGFR 3组145例。结果与老年组比较,高龄组年龄、糖尿病和冠心病患病、尿酸、夜间收缩压、24h收缩压负荷水平明显增高,TC、LDL-C、eGFR、24h舒张压、夜间收缩压下降、夜间舒张压下降明显降低(P<0.05,P<0.01)。多因素分析显示,24h收缩压标准差是血压控制良好的老年及高龄老年患者肾功能下降的独立危险因素。结论在血压控制良好的老年男性高血压患者中,只有24h收缩压标准差是肾功能下降的独立危险因素,改善血压变异性是延缓肾功能下降的重要治疗内容。Objective To study the correlation between blood pressure variability and renal function in old and very old male hypertensive patients with their blood pressure well controlled. Methods Four hundred and thirteen elderly male hypertensive patients were divided into 〈80 years old group（n=196） and ≥80 years old group（n=217）. Their blood pressure and its variability were monitored for 24 ambulatory hours. Their 24 h systolic and diastolic blood pressures were expressed as standard deviation and renal function was estimated according to their glomerular filtration rate（GFR）. The patients were divided into GFR group 1（n=89） with their GFR≥ 90 ml/ （min · 1.73 m^2）,GFR group 2（n=179） with their GFR being 60-89 ml/（min · 1.73 m^2） and GFR group 3（n=145） with their GFR〈60 ml/（min · 1.73 m^2）. Results The age,the incidence of diabetes mellitus and coronary heart disease,the uric acid level, the systolic and diastolic blood pressures were significantly higher whereas the GFR,the 24 h diastolic blood pressures,the nocturnal systolic and diastolic blood pressures were significantly lower in≥ 80 years old group than in ~80 years old group（P〈0.05 ,P〈0. 01）. Multivariate analysis showed that the standard deviation of 24 systolic blood pressures was an independent risk factor for the impairment of renal function in old and very old hypertensive patients with their blood pressure well controlled. Conclusion Only the standard deviation of 24 systolic blood pressures is an independent factor for the impairment of renal function in elderly hypertensive patients with their blood pressure well controlled. Impairment of renal function can be delayed by improving the blood pressure variability.

关 键 词：高血压 肾功能不全 抗高血压药 血压监测 便携式 危险因素 

分 类 号：R544.1[医药卫生—心血管疾病]