上海市老年高血压患者长时血压变异性与肾脏损害的关联  

Association of long-term blood pressure variability and renal damage in elderly patients with hypertension in Shanghai

作　　者：吴菲 严青华[1] 王玉恒[1] 杨沁平 刘丽丽 徐璐璐 常兆玉 程旻娜[1] 施燕[1] WU Fei;YAN Qinghua;WANG Yuheng;YANG Qinping;LIU Lili;XU Lulu;CHANG Zhaoyu;CHENG Minna;SHI Yan(Division of Chronic Non-communicable Disease and Injury,Shanghai Municipal Center for Disease Control and Prevention,Shanghai,200336,China)

机构地区：[1]上海市疾病预防控制中心慢性非传染病与伤害防治所,上海200336

出　　处：《中华高血压杂志》2023年第8期734-740,共7页Chinese Journal of Hypertension

基　　金：上海市加强公共卫生体系建设三年行动计划(2020—2022年)(GWV-7);上海市加强公共卫生体系建设三年行动计划(2020—2022年)公共卫生重点学科建设项目(GWV-10.1-XK16);上海市公共卫生体系建设三年行动计划学科建设项目(GWV-10.1-XK05)。

摘　　要：目的 探索老年高血压患者中长时血压变异性与肾脏损害的关联。方法 选取上海市2020年10月1日至2021年9月30日接受社区健康管理的原发性高血压患者,其中存在肾脏损害的对象作为高血压伴肾脏损害组,在未发生肾脏损害的对象中根据伴肾脏损害组的年龄(±2岁)、性别以及接受健康管理的社区进行1∶1匹配,作为高血压无肾脏损害组。回顾性分析自动化诊室血压测量结果,采用条件logistic回归模型分析长时血压变异性与肾脏损害的关联,应用4种不同的长时血压变异性指标和亚组分析探索其稳定性。结果 共纳入936例研究对象,伴肾脏损害组和无肾脏损害组各468例。伴肾脏损害组的收缩压标准差、变异系数、平均真实变异性、独立于均值变异与无肾脏损害组间的差异有统计学意义(均P<0.05),但舒张压标准差、变异系数、平均真实变异性、独立于均值变异在两组间的差异均无统计学意义。将血压变异性指标以二分类变量纳入条件logistic回归模型,调整混杂因素后显示,与收缩压标准差、收缩压变异系数、收缩压平均真实变异性、收缩压独立于均值变异四个指标的正常组相比,异常组肾脏损害的风险分别是其1.388(95%CI 1.055~1.825)、1.385(95%CI 1.049~1.829)、1.512(95%CI 1.134~2.015)、1.404(95%CI 1.067~1.847)倍,但舒张压相关指标未发现类似统计学关联。将血压变异性指标以连续性自变量纳入模型或亚组分析,结果均与前述结论基本一致,关联较为稳定。结论 老年高血压患者中长时收缩压变异性与肾脏损害存在关联,在今后社区慢性病健康管理中应当多加关注血压变异性情况,帮助患者维持血压稳定,对于预防和减缓老年高血压患者靶器官损害的发生和发展具有积极作用。Objective To evaluate the association of long-term blood pressure variability and renal damage in elderly patients with hypertension in Shanghai.Methods The essential hypertensive patients who were followed up from October 1,2020to September 30,2021and diagnosed with renal damage were assigned to case group.The control group was selected from patients who were not diagnosed with renal damage by 1∶1matching according to age(±2 years),gender and community health center of patients in the case group.The data of visit-to-visit automated office blood pressure was retrospectively analyzed.The logistic regression model was used to analyze the association of long-term blood pressure variability and renal damage.Four different indices of blood pressure variability and sub-group analysis were applied to ascertain the stability of the association.Results A total of 936subjects were final-ly included in the analysis,468in case group and 468in control group.The standard deviation of systolic blood pres-sure(SSD),coefficient of variation of systolic blood pressure(SCV),average reality variability of systolic blood pressure(SARV)and variation independent of mean systolic blood pressure(SVIM)in the case group were signifi-cantly higher than those in the control group(all P<0.05),but there was no significant difference between the two groups referring to diastolic blood pressure.After adjusting the confounding factors,the logistic regression model showed that the risk of renal damage in abnormal SSD group,abnormal SCV group,abnormal SARV group and ab-normal SVIM group was 1.388(95%CI 1.055-1.825),1.385(95%CI 1.049-1.829),1.512(95%CI 1.134-2.015),1.404(95%CI 1.067-1.847)times higher than those in normal group respectively.However,no signifi-cant association was found related to diastolic blood pressure.The result was basically consistent when the blood pressure variability indices were included as continuous variable in the model or subgroup analysis was conducted,which indicated that the association was relatively stable.Concl

关 键 词：高血压 长时血压变异性 肾脏损害 自动化诊室血压 

分 类 号：R544.1[医药卫生—心血管疾病] R692[医药卫生—内科学]