高血压患者随诊间血压变异性与脑卒中事件的相关性  

The association between blood pressure variability during visits and stroke in hypertensive patients

作　　者：李婷[1] 独梅枝 徐丽 陈培培[1] 蔡可选 乔程[1] 魏峥 娄培安[1,3] LI Ting , DU Mei-zhi, XU Li, CHEN Pei-pei, CAI Ke-xuan, QIAO Cheng, WEI Zheng, LOU Pei-an(The Department of Non-communicable Disease Prevention and Control, Xuzhou Certer for Disease Prevention and Control, Xuzhou Jiangsu 221006, Chin)

机构地区：[1]徐州市疾病预防控制中心慢性非传染性疾病防制科,江苏徐州221006 [2]徐州市沛县疾病预防控制中心 [3]徐州医科大学公共卫生学院

出　　处：《中华高血压杂志》2018年第2期144-149,共6页Chinese Journal of Hypertension

基　　金：徐州市2008年科技计划项目(XM08C041)

摘　　要：目的探究随访管理高血压患者脑卒中事件与随诊间血压变异性(BPV)的关联。方法 2014年10月,采用多阶段随机整群抽样方法,在江苏省徐州市沛县11家乡镇卫生院所辖的73家社区卫生服务站随机抽取4007例高血压患者进行问卷调查和体格检查,于2014年10月至2015年10月间进行5次随访测量血压情况,分析随诊间BPV与脑卒中事件的相关性。结果最终3691例研究对象入选,平均年龄(62.0±8.1)岁,随访期间血压平均值为(141.5±7.6)/(88.1±4.9)mm Hg,收缩压变异系数(SBPV)为(8.1±4.1)%,舒张压变异系数(DBPV)为(9.1±4.4)%。发生事件组SBPV、DBPV大于未发生事件组,差异具有统计学意义[(13.1±5.1)%比(8.1±4.1)%,(11.0±5.1)%比(9.0±4.4)%;均P<0.05];按年龄、文化程度、中心性肥胖、近期是否接受抗高血压治疗、血压是否控制、糖尿病、平均血压水平分层后,不同层间SBPV差异有统计学意义(P<0.05)。随访管理期间,共发生脑卒中事件21例,发生率为0.57%。Logistic回归分析表明,未校正任何因素前,SBPV、DBPV对脑卒中事件的OR值(95%CI)分别为1.22(1.13~1.31)、1.09(1.00~1.19),调整混杂因素后,SBPV、DBPV对脑卒中事件的OR值(95%CI)分别为1.21(1.12~1.30)、1.09(0.99~1.19)。结论 SBPV对于脑卒中事件的影响较大,很可能是脑卒中的强预测因子。Objective To investigate the association between blood pressure variability （BPV） during visits and stroke in hypertensive patients. Methods Using the multistage randomized cluster sampling, a total of 4007 pa- tients with hypertension were randomly selected from 73 community health service stations at 11 local hospitals in Peixian, City of Xuzhou, Jiangsu Province. Those patients were examined by questionnaires and physical examinations in October 2014. From October 2014 to October 2015, 5 follow-up visits were conducted to measure blood pressures. The association between BPV during follow-up visits and stroke events was analyzed. Results A total of 3691 patients were finally enrolled. The mean age was （62.0±8.1） years old. The mean blood pressure in all patients were （141.5±7.6）/（88.1±4.9） mm Hg. During follow-up period, the mean systolic blood pressure var- iability （SBPV） was （8.1±4.1）% and the mean diastolic blood pressure variability （DBPV） was （9.1±4.4）%. There were significant differences in SBPV among different groups after stratified by age, education, central obesity, antihypertensive treatment, the status of blood pressure control, diabetes and blood pressure values （P〈0.05 ）. During follow-up period, there were 21 cases of stroke developed （0.57%）. SBPV and DBPV in patients with sroke was higher than that in patients without stroke[（13.1±5.1）% vs （8.14-4.1）%, （11.0±5.1）% vs （9.0±4.4） % ; both P〈0.05]. Prior to adjusting for the potential confounding factors, SBPV and DBPV were associated with stroke with an odds ratio （95 % confidence interval） of 1.22 （ 1.13-1.31 ） and 1.09 （ 1.00-1.19） respectively. After adjusting for the potential confounding factors, the respective OR （ 95 M CI） were 1.21 （ 1.12- 1.30） and 1.09 （ 0. 99-1.19 ） respectively. Conclusion SBPV has a significant impact on stroke events and can be a strong predic- tor factor for stroke.

关 键 词：随访管理 高血压患者 血压变异性 脑卒中事件 

分 类 号：R544.1[医药卫生—心血管疾病]