老年人单纯收缩期高血压伴低舒张压与冠状动脉病变的相关性  

Correlation of diastolic blood pressure and isolated systolic hypertension with coronary heart disease in theelderly

作　　者：张晶[1] 王伟[1] 陈孟英[1] 梁蓉[1] 

机构地区：[1]天津市胸科医院心内科,300051

出　　处：《中华老年医学杂志》2013年第7期705-707,共3页Chinese Journal of Geriatrics

摘　　要：目的探讨未经抗高血压治疗的老年单纯收缩期高血压（ISH）患者伴低舒张压（〈70mmHg，1mmHg=0．133kPa）与冠状动脉粥样硬化、冠心病的相关性及发生低舒张压的危险因素。方法人选246例接受冠状动脉造影检查的未经治疗老年ISH患者，按照舒张压水平分为低舒张压组102例和非低舒张压组144例，分析低舒张压患者的冠状动脉粥样硬化和冠心病风险，并分析发生低舒张压的危险因素。结果收缩压低舒张压组（156．2±15．6）mmHg和非低舒张压组（154．4±14．2）mmHg比较，差异无统计学意义（t=0．93，P〉0．05），脉压低舒张压组（91．3±17．7）mmHg高于非低舒张压组（72．9±15．1）mmHg（t=8．54，P〈0．01）。多因素Logistic逐步回归分析结果显示，发生低舒张压的独立危险因素包括年龄、糖尿病和吸烟。用多因素Logistic回归对性别、年龄等常见心血管危险因素调整后，ISH伴低舒张压与冠状动脉粥样硬化和冠心病的发生相关（OR=1．72，95％CI：1．08-2．72；OR=1．44，95％CI：1．04-1．99，均P〈0．05）。结论在未经治疗的老年ISH患者中，低舒张压与冠状动脉粥样硬化和冠心病的发生相关，年龄、糖尿病和吸烟是低舒张压的独立危险因素。Objective To investigate the correlation of diastolic blood pressure （DBP） 〈 70 mm Hg and isolated systolic hypertension （ISH） with coronary atherosclerosis （CAS） and coronary heart disease （CHD） in elderly patients and to analyze the independent risk factors for low DBP. Methods A total of 246 elderly patients with untreated ISH who underwent coronary angiography were divided into the low DBP group （n= 102） and the non-low DBP group （n= 144） according to DBP level. All clinical and angiographic data were collected and the retrospective analysis was performed to assess the risk of CAS and CHD in patients with low DBP and to analyze the risk factors for low DBP. Results There were no significant differences in systolic pressure level between the IowDBP group and the non-lowDBPgroup 〈（156.2±15.6） mm Hgvs. （154.4±14.2） mmHg, t 0.93,P〉0. 051, while pulse pressure level was significantly higher in the low DBP group than in the non lowDBP group [（91. 3±17. 7） mm Hg vs. （72.9±15.1） mm Hg,t=8.54,P〈0. 011. Stepwise logistic analysis showed that age, diabetes and smoking were independent risk factors for low DBP. After adjustment for age, gender and other common risk factors, low DBP was independently associated with CAS and CHD （OR 1.72 and 1.44, 95% CI： 1.08-2.72 and 1.04-1.99, respectively, both P〈0.05）. Conclusions Low DBP is independently associated with CAS and CHD in elderly patients with untreated ISH. Age, diabetes and smoking are the independent risk factors for low DBP.

关 键 词：高血压 动脉粥样硬化 冠心病 

分 类 号：R544.1[医药卫生—心血管疾病]