高龄老年高血压动态血压特点及与高血压介导的器官损害相关分析  

The circadian rhythm characteristics of blood pressure and its correlation with hypertension-mediated organ damage in senile patients with hypertension

作　　者：魏伟[1,3] 孟超 金贤[2] 方宁远[1] Wei Wei;Meng Chao;Jin Xian;Fang Ningyuan(Department of General Practice,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai,200127,P.R.China;Department of Geriatrics,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai,200127,P.R.China;Department of Geriatrics,Jiading District Central Hospital Affiliated to Shanghai University of Medicine&Health Sciences,Shanghai,201800,P.R.China)

机构地区：[1]上海交通大学医学院附属仁济医院全科医学科,上海200127 [2]上海交通大学医学院附属仁济医院老年科,上海200127 [3]上海健康医学院附属嘉定区中心医院老年科,上海201800

出　　处：《老年医学与保健》2021年第4期711-714,718,共5页Geriatrics & Health Care

基　　金：上海申康医院发展中心第三批慢病防治项目(SHDC12015317)。

摘　　要：目的分析高龄老年高血压患者血压昼夜节律特点及其与高血压介导的器官损害相关关系。方法研究对象为在上海交通大学医学院附属仁济医院老年病科2019年1月-2020年1月住院的高龄患者,收集患者人口学资料、住院期间临床资料、生化检验指标及相关检查资料。共纳入资料完整患者122例,分析患者血压昼夜节律的特点及其与高血压介导的器官损害的相关关系。结果122例高龄老人中,动态血压监测报告显示杓型血压节律为12例(9.8%),非杓型血压节律为78例(64%),反杓型血压节律为32例(26.2%),未发现超杓型血压节律患者。组间比较显示:杓型组与非杓型组之间24 h收缩压变异性(P<0.05)和夜间平均舒张压(P<0.05)差异有统计学意义,而2组间动态动脉硬化指数(AASI)差异无统计学意义;杓型组与反杓型组之间,夜间平均收缩压(P<0.05)和夜间平均舒张压(P<0.05)差异有统计学意义,而2组间动态动脉硬化指数(AASI)差异无统计学意义。卡方检验显示,非杓型组发生高血压介导的器官损害多于杓型组(χ^(2)=9.482,P=0.002),反杓型组发生高血压介导的器官损害多于杓型组(χ^(2)=6.569,P=0.01)。杓型组与非杓型组所有病例Logistic回归显示,24h收缩压变异性是发生高血压介导的器官损害的独立危险因素;受试者工作特征(ROC)曲线显示,24 h收缩压变异性大于8.88的高龄老人更容易发生高血压介导的器官损害。杓型组与反杓型组所有病例Logistic回归显示,反杓型血压节律是发生高血压介导的器官损害的独立危险因素。结论24 h收缩压变异性独立并显著的增加了高龄老人靶器官损害,反杓型血压节律的高龄老人更容易发生靶器官损害。Objective To analyze the circadian rhythm characteristics of blood pressure(BP)and its correlation with hypertension-mediated organ damage in senile patients with hypertension.Methods The research subjects were the senile patients admitted to the Department of Geriatrics of Renji Hospital from January 2019 to January 2020.Their demographic data and clinical data during hospitalization were collected.A total of 122 patients with complete data were included.The circadian rhythm characteristics of BP and its correlation with hypertensive-mediated organ damage were analyzed.Results Among the 122 senile patients,12 cases(9.8%)with dipper BP,78 ones(64%)with non-dipper BP,32 ones(26.2%)with reverse dipper BP,and no patients with super-dipper BP were found.There were significant differences in 24-hour systolic blood pressure(SBP)variability(P<0.05)and night mean diastolic blood pressure(DBP)(P<0.05)between dipper BP group and non-dipper BP group.There were significant differences in night mean SBP(P<0.05)and night mean DBP(P<0.05)between dipper BP group and reverse dipper BP group.Chi-square test showed that hypertension-mediated organ damage in the non-dipper BP group was significantly more than that in the dipper BP group(χ^(2)=9.482,P=0.002),and the hypertension-mediated organ damage in the reverse dipper BP group was significantly more than that in the dipper BP group(χ^(2)=6.569,P=0.01).Multivariate logistic regression showed that 24-hour SBP variability was an independent risk factor for hypertension-mediated organ damage in both dipper BP group and non-dipper BP group.Receiver operating characteristic(ROC)curve showed that 24-hour SBP variability greater than 8.88 was an independent risk factor for hypertension-mediated organ damage.Multivariate logistic regression of all cases in both dipper group and reverse dipper group showed that reverse dipper BP was an independent risk factor for the occurrence of hypertension-mediated organ damage.Conclusion 24-hour SBP variability independently and significantly increa

关 键 词：高龄 动态血压监测 昼夜节律 高血压介导的器官损害 

分 类 号：R544.1[医药卫生—心血管疾病]