诊间血压变异性对老年高血压患者血管内皮功能的影响  

Impact of visit-to-visit blood pressure variability on vascular function in elderly hypertensive patients

作　　者：刘启云[1,2] 刘莹莹 韩军丽[1,2] 李江华 董少红[1,2] 

机构地区：[1]暨南大学第二临床医学院 [2]深圳市人民医院心内科,广东深圳518020

出　　处：《南方医科大学学报》2015年第9期1320-1324,共5页Journal of Southern Medical University

基　　金：深圳市科技计划项目基金(201303003)

摘　　要：目的评价老年高血压患者的诊间血压变异性(blood pressure variability,BPV)与血管内皮功能之间的关系。方法入选174例老年原发性高血压患者,每月门诊测量患者血压,随访12个月,计算每例研究对象随访期间的平均收缩压(SBP)、平均舒张压(DBP)及其标准差、变异系数。随访结束后行超声检查评估血管内皮功能,计算肱动脉的内皮依赖性血流介导的血管舒张功能(flow-mediated vasodilation,FMD)、非内皮依赖性硝酸甘油介导的血管舒张功能(nitroglycerine-mediated vasodilation,NMD)及FMD/NMD,分别按FMD%及FMD/NMD分为内皮功能正常组和内皮功能下降组,比较基线特征及BPV情况。采用多元线性回归分析BPV对血管内皮功能的影响。结果按FMD/NMD分组显示内皮功能下降组的FMD%低于内皮功能正常组,NMD%及血压变异性指标均高于内皮功能正常组,差异均有统计学意义(P<0.05)。内皮功能正常组使用钙离子拮抗剂的比率高于内皮功能下降组(79.55%比63.95%,P<0.05)。多元线性回归分析显示调整年龄、BMI和血压水平之后,BPV与FMD/NMD显著负相关(P<0.05)。结论 FMD/NMD较FMD能更好的反应血管内皮功能,BPV升高的老年高血压病患者存在内皮功能不全。Objective To assess the relationship between visit- to- visit blood pressure（BP） variability（BPV） and vascular endothelial function in a cohort of elderly hypertensive patients. Methods A total of 174 elderly patients with essential hypertension were included in the study. The participants had their office BP measured during the 12-month follow-up. Right brachial artery diameter was assessed at rest, during reactive hyperemia（flow- mediated dilation, FMD）, and after nitroglycerin administration（nitroglycerin- mediated dilation, NMD）. The participants were divided into two groups according to FMD% or FMD/NMD ratio. The correlations between BPV and endothelial function were analyzed by univariate analysis and multiple linear regression analysis. Results The participants classified as having a decreased endothelial function according to FMD/NMD ratio had significantly lower FMD% and higher BPV and NMD%（P〈0.05）. The percentage of CCBs use in normal endothelial function group was significantly higher than that in decreased endothelial function group（79.55% vs 63.95%, P〈0.05）. Multiple linear regression analysis revealed a significant negative association between FMD/NMD ratio and BPV, and this association remained significant after adjustment for age, body mass index, and mean BP levels.Conclusions FMD/NMD ratio is a better marker of endothelial function than FMD, and an increased visit-to-visit variability of BP is associated with a decreased endothelial function.

关 键 词：高血压 血压变异性 内皮功能 

分 类 号：R544.1[医药卫生—心血管疾病]