诊所血压正常的高龄高血压患者夜间低血压现象分析  

Analysis of nocturnal hypotension in very elderly hypertensive patients with normal office blood pressure

作　　者：李远方[1] 西雁[1] 钱菊英[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科、上海市心血管病研究所,200032

出　　处：《上海医学》2014年第7期559-563,共5页Shanghai Medical Journal

摘　　要：目的 分析诊所血压〈140/90mmHg（1mmHg=0.133kPa）、高龄（年龄≥80岁）的高血压患者夜间低血压（NHP）现象的发生情况及其与服用降压药间的关系,探讨能预测NHP发生的动态血压监测（ABPM）指标的临界值。方法 选取在复旦大学附属中山医院心内科老年病房连续住院的52例诊所血压〈140/90mmHg的高龄高血压患者,男36例,女16例,平均年龄为（86.2±4.8）岁。所有患者均行ABPM,根据ABPM结果将患者分为有NHP现象组和无NHP现象组。比较两组患者的血压特点和服用降压药物的情况,以及ABPM的各项数据。NHP的定义为夜间平均动脉压（MAP）〈70mmHg,检验以不同的ABPM临界值预测NHP的效力。结果 有NHP现象组41例（78.8%,41/52）,无NHP现象组11例（21.2%,11/52）。NHP现象发生的次数占每例患者各自血压测量次数的0~38%（中位数为4.5%）。有NHP现象组的诊所收缩压（SBP）为（123.3±12.7）mmHg,显著低于无NHP现象组的（131.8±3.4）mmHg（P〈0.05）;有NHP现象组服用降压药物的种类为2.2（1~4）种,显著多于无NHP现象组的1.3（0~3）种。无NHP现象组的SBP和舒张压（DBP）的24h平均值、白天平均值、夜间平均值、夜间最低值均显著高于有NHP现象组（P值均〈0.05）,而两组间SBP和DBP的夜间下降值、夜/昼比值的差异均无统计学意义（P值均〉0.05）。以偏相关分析校正年龄、高血压病史、体质指数等混杂因素后,DBP夜间最低值与降压药物种类数呈负相关（r=-0.487,P=0.002）。以SBP 24h平均值≤140mmHg和（或）DBP 24h平均值≤72mmHg预测NHP发生的灵敏度为93.2%（41/44）,特异度为7/8,总符合率为92.3%（48/52）。单用SBP 24h平均值≤140mmHg预测NHP发生的灵敏度为90.5%（38/42）,特异度为7/10,总符合率为86.5%（45/52）;或单用DBP 24h平均值〈72mmHg预测NHP发生的灵敏度为94.9%（37/39）,特异度为9/13,总符合率为88.5%（46/52）。结论 诊所血压〈140/90mObjective To evaluate the presence of nocturnal hypotension （NHP） and its relationship with antihypertensive drugs in hypertensive patients （≥80 years old） with office blood pressure under 140/90 mmHg （1 mmHg= 0. 133 kPa）, and to explore the cut-off value in ambulatory blood pressure monitoring （ABPM） that can predict episode of NHP, Methods A total of 52 elderly hypertensive patients consecutively enrolled in our hospital with office blood pressure under 140/90 mmHg were observed in this cross-sectional study. There were 36 males and 16 females with an average age of （86.2± 4.8） years. ABPM was recorded and analyzed. The NHP was defined as the mean nocturnal blood pressure less than 70 mmHg. The patients were divided into two groups according to whether or not NHP was observed on ABPM data. The characteristics of the ABPM data, clinical patterns and administration of antihypertensive drugs were compared between the two groups. Efficacy of possible cut-off ABPM values was also examined. Results There were 41 patients with NHP （78.8%,41/52） and 11 patients without NHP （21.2%, 11/52）. The median percentage of NHP recordings among total blood pressure （BP） recordings was 4.5% （range, 0- 38.5% ）. Clinical systolic blood pressure （SBP） was significantly lower in patients with NHP than that in the patients without NHP （[123, 3 ± 12.7] mmHg vs. [131.8 ±3.4] mmHg, P〈 0.05）. Patients with NHP were treated with more antihypertensive drugs as compared with those without NHP （2.22 vs. 1.3）. The values of 24 h BP including SBP and diastolic blood pressure （DBP）, daytime BP, nocturnal BP and the lowest nocturnal BP were significantly higher in patients without NHP than those with NHP （all P〈 0.05）, while there were no significant differences in terms of decreased nocturnal SBP, DBP or ratio of daytime BP to nocturnal BP between two groups （all P〉0.05）. After modification of age, hypertension history and body mass index （BMI）, partial correlation analysi

关 键 词：高龄 高血压病 低血压 动态血压监测 

分 类 号：R544.1[医药卫生—心血管疾病]