住院高血压合并冠心病患者餐后低血压的临床观察  

Clinical observation of postprandial hypotension in patients with hypertensive and coronary heartdisease

作　　者：张亚楠[1] 陈天磊 耿雪[1] 谷国强[1] 郑红梅[1] 杨晓红[1] 张冀东[1] 谢瑞芹 崔炜[1] Zhang Yanan;Chen Tianlei;Geng Xue;Gu Guoqiang;Zheng Hongmei;Yang Xiaohong;Zhang Jidong;Xie Ruiqin;Cui Wei(First Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心内一科、河北省心血管研究所,石家庄050000 [2]河北省人民医院心内六科,石家庄050000

出　　处：《中华医学杂志》2018年第33期2641-2644,共4页National Medical Journal of China

基　　金：河北省医学科研基金（20170570）

摘　　要：目的观察住院原发性高血压合并冠心病患者餐后血压变化情况，了解餐后低血压（PPH）的发生情况、临床特点及相关影响因素。方法选取2013年12月至2014年12月在河北医科大学第二医院心内科住院治疗的原发性高血压合并冠心病患者197例，测量患者早、午、晚餐餐前血压及餐后30、60、90、120main血压值，根据是否发生PPH，分为PPH组（n=37）和非PPH组（NPPH组n=160），并观察两组之间的临床特点、相关因素、住院期间心脑血管不良事件发生情况。结果住院原发性高血压合并冠心病患者197例中，37例患者在不同餐次出现至少一次PPH，PPH的发生率18．8％。早餐和晚餐后PPH的发生率高于午餐后PPH的发生率（P〈0．05）。进餐时的体位、不同年龄组、合并不同疾病之间的PPH发生率无差异。根据患者三餐前收缩压平均值，将其分为四组（〈120mmHg、120～129mmHg、130～139mmHg、〉140mmHg）（1mmHg=0．133kPa），餐前基础收缩压水平越高，其PPH发生率越高。PPH会增加患者住院期间不良事件的发生。结论住院原发性高血压合并冠心病患者的PPH发生率为18．8％。早餐和晚餐的PPH发生率较午餐高，较高的基础收缩压水平是PPH的危险因素，PPH会导致患者住院期间心脑血管不良事件的增加。Objective To explore the prevalence and clinical characteristics of postprandial hypotension（PPH） in patients with essential hypertension and coronary heart disease. Methods A total of 197 patients with essential hypertension and coronary heart disease, who had been treated in the First Department of Cardiology of the Second Hospital of Hebei Medical University from December, 2013 to December, 2014 were included. The patients＇ blood pressure before breakfast, lunch and dinner and 30, 60, 90, 120 minutes after the meal were monitored. Subjects were classified into PPH group （n =37） and non-PPH group （NPPH, n = 160） according to postprandial decrease in systolic blood pressure, to explore the clinical characteristics and related factors and the major adverse cardiac and cerebral vascular events of PPH. Results Among 197 patients, 37 cases （18.8%） showed at least once postprandial decline in systolic blood pressure greater than and equal to 20 mmHg. The incidence of PPH after breakfast and dinner were higher than lunch （ P 〈 0. 05 ）. There was no significant difference in the incidence of PPH among different age groups, among patients accompanied with different diseases, and among patients with different dining position （ all P 〉 0.05 ）. According to the baseline systolic blood pressure, patients can be divided into 4 groups（ 〈 120 mmHg, 120 - 129 mmHg, 130 - 139 mmHg, 〉 140 mmHg）, the higher the level of the baseline systolic blood pressure was, the higher the incidence of PPH was. And the incidence of major adverse cardiac and cerebral vascular events in patients during hospitalization were increased by PPH. Conclusions The prevalence of PPH in the patients with essential hypertension and coronary heart disease is 18.8%. The incidence of PPH after breakfast and dinner is higher than lunch. The baseline systolic bloodpressure is considered to be the risk factor of PPH. And PPH could lead to an increase of the incidence of major adverse cardiac and cerebral vascular events.

关 键 词：餐后低血压 原发性高血压 冠心病 

分 类 号：R544.1[医药卫生—心血管疾病]