高血压患者伴发餐后低血压现象与颈动脉粥样硬化的关系  

The relationship between postprandial hypotension and carotid artery atherosclerosis in hypertensive patients

作　　者：王锋顺 商黔惠[1,2] 邹焰[3] 王晓春[1] 陈剑玲[1,2] 王希[2] 

机构地区：[1]遵义医学院临床医学研究所,心血管病研究所,高血压研究室,贵州遵义563003 [2]遵义医学院附属医院心内科,贵州遵义563003 [3]遵义医学院公共卫生学院流行病与统计学教研室,贵州遵义563003

出　　处：《中华高血压杂志》2015年第7期633-638,共6页Chinese Journal of Hypertension

基　　金：国家自然科学基金资助项目(81160041);贵州省社会发展攻关计划项目[黔科合SY字(2011)3047]

摘　　要：目的 观察原发性高血压（EH）患者餐后血压变化规律;探讨餐后低血压（PPH）与颈动脉粥样硬化的关系。方法 选择资料齐全、能配合完成血压测量的EH住院患者118例,对所有入选者均测量三餐前5min、三餐后2h内每间隔15min的血压。根据餐后低血压诊断标准分为PPH组（n=83）和非PPH（NPPH）组（n=35）。应用高分辨率彩色多普勒超声检测患者的颈动脉内膜中层厚度（IMT）、斑块性质,计算斑块Crouse积分及粥样硬化等级积分。分析两组餐后的血压变化及其与颈动脉粥样硬化的关系。结果 EH住院患者的PPH检出率为70.3%,早餐后PPH的检出率（50.1%）高于中餐后（35.6%）和晚餐后（27.8%）（P〈0.0167）;PPH组早餐后收缩压和舒张压的下降最大值大于中餐后和晚餐后（P〈0.05）。PPH组颈动脉斑块检出率、斑块数量、斑块Crouse积分及粥样硬化等级积分大于NPPH组[69.7%比37.5%,1（0-3）比0（0-1）,2.1（0-5.2）比0（0-1.9）,2（1-2）比0.5（0-2）;均P〈0.05];PPH组患者的颈动脉斑块多为硬斑块（59.8%）,而NPPH组多为软斑块（46.2%）和混合斑块（38.4%）（P〈0.05）;颈动脉斑块形成患者的PPH检出率和早餐后收缩压最大下降幅度均大于无颈动脉斑块形成者[81.5%比53.5%,（23.1±2.3）比（17.4±2.7）mmHg;均P〈0.05]。多元Logistic逐步回归分析显示,早餐前收缩压水平（OR=2.30,95%CI1.32-3.99）、年龄（OR=2.21,95%CI 1.02-4.78）、颈动脉粥样硬化等级积分（OR=2.69,95%CI1.52-4.76）是EH患者发生PPH的独立影响因素。结论 EH住院患者常合并PPH,早餐后检出率最高;EH伴发PPH与颈动脉粥样硬化及其程度和斑块性质有关。Objective To characterize the changes of postprandial hypotension（PPH）in patient with essential hypertension（EH）,and to investigate the relationship between PPH and carotid artery atherosclerosis. Methods One hundred and eighteen hospitalized EH patients with well-documented information were recruited. Blood pressure（BP）was measured at 5min before three daily meals and every 15 min interval within 2hafter meals. According to the changes of systolic blood pressure（SBP）after meals,all subjects were divided into two groups：PPH group（n=83）and non-postprandial hypotension group（NPPH,n=35）. The high frequency ultrasonography was performed to detect the intima-media thickness（IMT）and plaque characteristics in carotid artery. The carotid artery plaque Crouse score and rating scale were calculated. The changes of PPH in EH patients and the relationship between PPH and carotid artery atherosclerosis were analyzed. Results Overall incidence of PPH in all the hospitalized patients was 70.3%,which was higher at breakfast（50.1%）than at lunch（35.6%）and supper（27.8%）（all P〈0.0167）. Moreover,the decreases in SBP and diastolic blood pressure（DBP）after breakfast were more obvious than that after lunch and after dinner（P〈0.05）. As compared to NPPH group,the detection rate of plaque（69.7% vs 37.5%）,number of plaque[1（0-3）vs 0（0-1）],Crouse score of plaque[2.1（0-5.2）vs 0（0-1.9）]and rating scale of carotid artery atherosclerosis[2（1-2）vs 0.5（0-2）]in PPH group were significantly increased（all P〈0.05）. The plagues in PPH group were mainly hard plague（59.8%）,while in NPPH group which were mainly soft plaques（46.2%）and mixed plaques（38.4%）（P〈0.05）.The detection rate of PPH（81.5% vs 53.5%）and the drop amplitude of postprandial blood pressure[（23.1±2.3）vs（17.4±2.7）mmHg]in patients with carotid atherosclerotic plaque were significantly higher than that without carotid atherosclerotic plaque. Logistic regression analysis i

关 键 词：原发性高血压 餐后低血压 颈动脉粥样硬化 

分 类 号：R544.1[医药卫生—心血管疾病] R543.4[医药卫生—内科学]