降压药物对老年单纯性收缩期高血压患者脑白质和认知功能的影响以及最佳降压目标值探讨  

The effect of antihypertensive treatment on white matter lesions and cognitive dysfunction in elderly patients with isolated systolic hypertension and discussion of optimal target systolic blood pressure

作　　者：黄芩[1] 马丽霞[1] 刘莎[2] 初丽敏 王晓静[1] 曹利[1] 魏树林[1] Huang Qin;Ma Lixia;Liu Sha;Chu Limin;Wang Xiaojing;Cao Li;Wei Shulin(Department of Geriatrics,the Third Hospital,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第三医院老年病科,石家庄050000 [2]石家庄市第三医院药学部,石家庄050000

出　　处：《中国循证心血管医学杂志》2018年第11期1358-1361,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：2015年石家庄市科学技术研究与发展指导计划(151461143)

摘　　要：目的探讨降压药物对老年单纯性收缩期高血压(ISH)患者脑白质和认知功能的影响以及最佳降压目标值。方法选择2014年1月～2014年12月于石家庄市第三医院老年病科及健康体检中心的457例ISH患者,随访3年,比较治疗前后患者的基线资料。采用简易智力状况检查量表(MMSE)评估患者的认知情况,并通过局部加权回归散点平滑法(LOWESS)评估收缩压(SBP)下降幅度和绝对值脑白质高信号体积(WMH)以及WMH/颅脑总体积(TIV)的相关性。结果随访3年后,饮酒和吸烟的患者人数明显减少,SBP、舒张压(DBP)、空腹血糖(FPG)、MMSE较治疗前降低,而WMH和WMH/TIV较基线值升高,差异有统计学意义(P<0.05)。与SBP下降幅度<10 mmHg组患者相比,SBP下降21～30 mmHg组和31～40 mmHg组患者WMH变化率更低,差异有统计学意义(P<0.05);SBP下降11～20mmHg、21～30 mmHg、31～40 mmHg、41～50 mmHg组患者WMH/TIV变化率更低,差异有统计学意义(P<0.05)。与SBP<130 mmHg组患者相比,SBP 141～150 mmHg组和151～160 mmHg组患者WMH变化率更低,差异有统计学意义(P<0.05);SBP下降141～150 mmHg组患者WMH/TIV变化率更低,差异有统计学意义(P<0.05)。结论老年单纯性收缩期高血压患者接受降压治疗时可以延缓脑白质损伤和认知功能障碍,最佳SBP目标值控制在141～150 mmHg,SBP下降幅度控制在21～40 mmHg时获益最大。Objective To investigate the effect of antihypertensive treatment on white matter lesions(WML)and cognitive dysfunction(CD)in elderly patients(≥65y)with isolated systolic hypertension(SBP)and the optimal target systolic blood pressure(ISH).Methods457elderly patients(≥65y)with ISH from January to December2017were enrolled into the study and followed up for three years.Patients'cognitive status was assessed using the Mini-Mental Condition Check Scale(MMSE),and systolic blood pressure(SBP)decline and absolute value of white matter high signal volume(WMH)and Correlation between WMH and total brain volume(TIV)were assessed by local weighted regression scatter(LOWESS).Results After3years of follow-up,the number of patients drinking and smoking was significantly reduced.SBP,diastolic blood pressure(DBP),fasting blood glucose(FPG),and MMSE were lower than those before treatment,while WMH and WMH/TIV were higher than baseline(P<0.05).Compared with patients with SBP decrease<10mmHg,the WMH rate of patients with SBP decreased by21~30mmHg and31~40mmHg group was lower,the difference was statistically significant(P<0.05);SBP decreased by11~20mmHg,21~30mmHg,the change rate of WMH/TIV in patients with31~40mmHg and41~50mmHg group was lower,and the difference was statistically significant(P<0.05).Compared with patients with SBP<130mmHg group,patients with SBP141~150mmHg group and151~160mmHg group had lower WMH rate,the difference was statistically significant(P<0.05);SBP decreased141~150mmHg group patients had lower WMH/TIV rate,and the difference was statistically significant(P<0.05).Conclusion Elderly patients with isolated systolic hypertension can delay white matter damage and cognitive dysfunction when receiving antihypertensive therapy.The optimal SBP target value is controlled at141~150mmHg,and the SBP decrease is controlled at21~40mmHg.

关 键 词：单纯性收缩期高血压 降压治疗 脑白质损伤 认知功能障碍 最佳目标值 

分 类 号：R544.1[医药卫生—心血管疾病]