动态血压监测指标指导临床治疗老年高血压的意义

张永军; 徐尚银; 吴祝霞; 樊紫青; 周文娇; 姚应水

doi:10.16462/j.cnki.zhjbkz.2019.07.009

动态血压监测指标指导临床治疗老年高血压的意义

doi: 10.16462/j.cnki.zhjbkz.2019.07.009

1.
241001 芜湖, 皖南医学院弋矶山医院电生理科
2.
241001 芜湖, 皖南医学院公共卫生学院

基金项目:

国家自然科学基金项目 81541071

安徽省科技厅公益性技术应用研究联动计划项目 1704f0804047

详细信息

通讯作者:
姚应水, E-mail: yingshuiyao@163.com

中图分类号: R544.1
计量
- 文章访问数: 532
- HTML全文浏览量: 188
- PDF下载量: 46
- 被引次数: 0
出版历程
- 收稿日期: 2019-02-20
- 修回日期: 2019-04-23
- 刊出日期: 2019-07-10

Guiding value of ambulatory blood pressure monitoring index in clinical prevention and treatment of elderly hypertensive population

1.
Department of Electrophysiological, Yijishan Hospital of Wannan Medical College, WuHu 241001, China
2.
School of Public Health, Wannan Medical College, WuHu 241001, China

Funds:

National Natural Science Foundation of china 81541071

Anhui Provincial Department of Science and Technology Public Welfare Technology Applied Research Project 1704f0804047

More Information

Corresponding author: YAO Ying-shui, E-mail: yingshuiyao@163.com

摘要

摘要: 目的通过监测高血压患者的动态血压，分析其对临床老年高血压人群防治工作的应用价值。方法监测2017年12月-2018年12月期间519例高血压患者的动态血压，按照60岁为分界点，分成≥ 60岁老年组264例， < 60岁中青年对照组255例，对血压、血压昼夜节律、脉压、血压变异系数、血压负荷值、平均心率、晨峰血压等系列指标进行临床分析。结果老年组动态血压昼夜节律异常发生率为76.5%，与对照组比较，舒张压、舒张压负荷值、脉压、24 h平均心率、收缩压变异系数、24 h舒张压变异系数、晨峰舒张压等指标两组间均有差异(均有P < 0.05)，且老年组中不同血压节律类型的24 h收缩压、夜间收缩压、夜间舒张压、夜间脉压、白天收缩压负荷值、夜间收缩压负荷值、24 h收缩压变异系数、24 h舒张压变异系数等指标均有差异(均有P < 0.05)。结论动态血压监测指标对老年高血压人群临床合理用药有一定的指导价值。
- 高血压 /
- 动态血压监测 /
- 昼夜节律 /
- 治疗
Abstract: Objective To study the application value of dynamic monitoring of blood pressure in the prevention and treatment of elderly hypertension. Methods 519 hypertensive patients from December 2017 to December 2018 were monitored with ambulatory blood pressure monitoring, and were divided into the elderly group (≥ 60 years old, 264 cases) and the control group (< 60 years old, 255 cases). The results of ambulatory blood pressure monitoring in two groups were analyzed, which inclued the circadian rhythm of blood pressure, blood pressure, pulse pressure, coefficient of variation of blood pressure, blood pressure load value, average heart rate and morning blood pressure surge. Results The incidence of abnormal circadian rhythm of ambulatory blood pressure in the elderly group was 76.5%. Compared with the control group, there were differences in the indexes of diastolic blood pressure (DBP), diastolic blood pressure load value (DBPLV), pulse pressure (PP), 24 h average heart rate (24 hAHR), systolic blood pressure coefficient of variation (SBPCV), 24 h diastolic blood pressure coefficient of variation (24 h DBPCV) and morning diastolic blood pressure surge (MDBPS) between the two groups(all P < 0.05). There were differences in 24 h systolic blood pressure (24hSBP), night systolic blood pressure (nSBP), night diastolic blood pressure (nDBP), night pulse pressure (nPP), day systolic blood pressure load value (dSBPLV), ninght systolic blood pressure load value (nSBPLV), 24 h SBPCV, 24 h dDBPCV and other indicators among different blood pressure types in the elderly group (all P < 0.05). Conclusion Ambulatory blood pressure monitoring indicators have important guiding value for the prevention and treatment of elderly hypertension.
- Hypertension /
- Ambulatory blood pressure monitoring /
- Circadian rhythm /
- Treatment and treatment

HTML全文

表 1 老年组与对照组昼夜血压类型的比较[n(%)]

Table 1. Comparisons of circadian blood pressure types between the elderly group and the control group [n(%)]

分组	杓型	非杓型	反杓型	超杓型	合计(异常率)
老年组	62(23.5)	110(41.6)	90(34.1)	2(0.8)	264(76.5)
对照组	76(29.8)	119(46.7)	58(22.7)	2(0.8)	255(70.2)
合计	138(26.6)	229(44.1)	148(28.5)	4(0.8)	519(73.4)

下载: 导出CSV

表 2 老年组和对照组各项指标的比较

Table 2. Comparison of indicators between the elderly group and the control group

指标	老年组(n=264)	对照组(n=255)	F值	P值
24hSBP(mmHg)	130.89±15.88	129.41±16.09	1.05	0.294
dSBP(mmHg)	132.09±15.95	129.66±18.30	1.61	0.109
nSBP(mmHg)	126.00±17.60	127.33±20.60	-0.79	0.432
24hDBP(mmHg)	86.58±12.36	75.22±9.81	11.62	< 0.001
dDBP(mmHg)	87.64±12.34	75.59±9.82	12.32	< 0.001
nDBP(mmHg)	82.27±14.74	73.50±11.58	7.55	< 0.001
24hPP(mmHg)	44.44±8.92	54.22±12.05	-10.48	< 0.001
dPP(mmHg)	44.66±9.19	54.00±12.12	-9.87	< 0.001
nPP(mmHg)	43.55±9.40	54.71±13.32	-10.99	< 0.001
24hSBPLV(%)	45.70±33.77	45.52±62.82	0.04	0.968
dSBPLV(%)	42.30±34.52	37.16±30.27	1.81	0.072
nSBPLV(%)	58.48±37.89	59.84±35.33	-0.42	0.672
24hDBPLV(%)	60.24±30.61	32.40±26.10	11.16	< 0.001
dDBPLV(%)	56.06±33.31	25.84±26.44	11.47	< 0.001
nDBPLV(%)	77.02±27.76	56.49±33.74	7.56	< 0.001
24hAHR(bpm)	74.07±9.95	69.53±9.47	5.33	< 0.001
dAHR(bpm)	75.85±11.22	71.05±9.65	5.23	< 0.001
nAHR(bpm)	65.60±10.70	63.88±9.86	1.92	0.056
24hSBPCV(%)	13.04±3.35	15.31±4.22	-6.78	< 0.001
dSBPCV(%)	12.69±3.65	15.12±4.48	-6.75	< 0.001
nSBPCV(%)	10.22±3.82	12.18±5.16	-4.90	< 0.001
24hDBPCV(%)	10.72±2.46	10.17±2.44	2.58	0.010
dDBPCV(%)	10.35±2.62	9.85±2.54	2.20	0.029
nDBPCV(%)	8.98±3.19	9.07±3.39	-0.32	0.750
MSBPS(mmHg)	132.08±17.06	132.94±18.91	-0.55	0.585
MDBPS(mmHg)	88.54±13.91	78.38±11.62	9.04	< 0.001

下载: 导出CSV

表 3 老年组不同血压类型各项指标比较

Table 3. Comparison of various blood pressure types in the elderly group

指标	杓型(n=62)	非杓型n=110	反杓型(n=90)	统计量F值	P值
24hSBP(mmHg)	130.95±13.96	126.53±16.47	131.97±16.69	3.225	0.041
dSBP(mmHg)	133.52±14.22	127.06±16.54	130.11±22.23	2.528	0.082
nSBP(mmHg)	121.23±14.35	123.21±18.24	137.24±23.13	17.465	< 0.001
24hDBP(mmHg)	75.94±8.88	73.87±9.69	76.63±10.37	2.153	0.118
dDBP(mmHg)	78.00±9.22	74.46±9.77	75.48±10.11	2.621	0.075
nDBP(mmHg)	67.23±7.95	71.52±9.72	80.82±11.64	37.979	< 0.001
24hPP(mmHg)	55.13±13.09	52.66±11.46	55.34±11.87	1.499	0.225
dPP(mmHg)	53.76±12.93	52.60±11.38	54.53±11.80	1.216	0.298
nPP(mmHg)	55.35±13.49	52.68±12.75	57.92±13.79	4.136	0.017
24hSBPLV(%)	45.03±27.18	36.42±29.32	57.33±99.22	2.766	0.065
dSBPLV(%)	43.90±27.64	31.76±29.37	39.08±32.26	3.526	0.031
nSBPLV(%)	47.97±32.91	53.09±35.73	77.60±28.79	19.539	< 0.001
24hDBPLV(%)	34.12±26.32	28.33±26.57	36.86±24.73	2.818	0.062
dDBPLV(%)	32.17±26.93	22.41±27.00	26.16±24.94	2.731	0.067
nDBPLV(%)	41.09±27.93	51.48±32.20	74.47±31.07	24.431	< 0.001
24hAHR(bpm)	70.61±9.45	68.99±8.55	69.46±10.62	0.581	0.560
dAHR(bpm)	72.29±9.65	70.64±8.80	70.73±10.73	0.655	0.520
nAHR(bpm)	64.16±10.17	63.15±9.18	64.58±10.55	0.543	0.581
24hSBPCV(%)	16.18±3.97	14.56±4.00	15.53±4.53	3.225	0.041
dSBPCV(%)	15.76±4.11	14.63±4.45	15.29±4.75	1.374	0.255
nSBPCV(%)	12.28±4.86	12.17±5.23	12.21±5.36	0.008	0.992
24hDBPCV(%)	11.19±2.27	9.49±2.20	10.23±2.60	10.320	< 0.001
dDBPCV(%)	10.29±2.47	9.38±2.40	10.12±2.69	3.367	0.036
nDBPCV(%)	9.45±3.38	8.95±3.18	9.00±3.68	0.470	0.626
MSBPS(mmHg)	135.15±16.52	130.94±19.71	133.95±19.56	1.160	0.315
MDBPS(mmHg)	79.46±10.57	77.58±11.66	79.02±11.87	0.661	0.517
注：^*超杓型临床发生例数较少未纳入分析。

下载: 导出CSV

参考文献(15)

[1]	Wang ZW, Chen Z, Zhang L, et al. Status of hypertension in China: results from the China hypertension survey, 2012-2015[J]. Circulation, 2018, 137(22): 2344-2356. DOI: 10.1161/circulation.117.032380.
[2]	瞿心远, 季文, 王新亚, 等. 高血压与中心性肥胖对心脑血管疾病的联合作用[J]. 中华疾病控制杂志, 2018, 22(7): 703-706. DOI: 10.16462/j.cnki.zhjbkz.2018.07.012. Qu XY, Ji W, Wang XY, et al. Combined effects of hypertension and central obesity on the risk of cardio-cerebrovascular diseases[J]. Chin J Dis Control Prev, 2018, 22(7): 703-706. DOI: 10.16462/j.cnki.zhjbkz.2018.07.012.
[3]	范晓涌, 魏翰文, 王世明, 等. 高血压患者24h动态血压昼夜节律与冠状动脉病变的关系[J]. 中华高血压杂志, 2018, 26(3): 280-283. DOI: 10.16439/j.cnki.1673-7245.2018.03.023. Fan XY, Wei HW, Wang SM, et al. The relationship between 24-hour ambulatory blood pressure circadian rhythm and coronary artery disease in patients with hypertension[J]. Chin J Hypertens, 2018, 26(3): 280-283. DOI: 10.16439/j.cnki.1673-7245.2018.03.023.
[4]	中国高血压防治指南修订委员会. 中国高血压防治指南2018修订版[J]. 心脑血管病防治杂志, 2019, 19(1): 1-44. https://www.cnki.com.cn/Article/CJFDTOTAL-XIXG201901003.htm Revision Committee of the Guidelines for the Prevention and Treatment of Hypertension in China. China hypertension prevention and treatment guidelines 2018 revised edition[J]. Prevention and Treatment of Cardio Cerebral Vascular Disease, 2019, 19(1): 1-44. https://www.cnki.com.cn/Article/CJFDTOTAL-XIXG201901003.htm
[5]	Krause T, Lovibond K, Caulfield M, et al. Management of hypertension: summary of NICE[J]. BMJ, 2011, 34(3): 489-491. DOI: 10.1136/bmj.d4891.
[6]	孟亚星, 张小玲, 严激. 原发性高血压伴血脂异常患者的动态血压特点[J]. 中国临床保健杂志, 2018, 21(3): 323-327. DOI: 10.3969/j.issn.1672-6790.2018.03.010. Meng YX, Zhang XL, Yan J. The characteristics of ambulatory blood pressure in patients with essential hypertension and dyslipidemia[J]. Chin J Clin Healthc, 2018, 21(3): 323-327. DOI: 10.3969/j.issn.1672-6790.2018.03.010.
[7]	王否, 顾佳怡, 徐辉, 等. 社区综合健康管理对老年高血压患者生活质量的影响[J]. 中华疾病控制杂志, 2018, 22(7): 708-711. DOI: 10.16462/j.cnki.zhjbkz.2018.07.013. Wang F, Gu JY, Xu H, et al. Effect of community comprehensive health management on quality of life in elderly hypertensive patients[J]. Chin J Dis Control Prev, 2018, 22(7): 708-711. DOI: 10.16462/j.cnki.zhjbkz.2018.07.013.
[8]	吴彩云, 李晓久, 邢晓娜, 等. 不同形式测量的血压与缺血性脑白质病变关系的研究进展[J]. 中华老年心血管病杂志, 2019, 21(1): 103-105. DOI: 10.3969/j.issn.1009-0126.2019.01.027. Wu CY, Li XJ, Xing XN, et al. Advances in the relationship between blood pressure measured in different forms and ischemic white matter lesions[J]. Chin J Geriatr Heart Brain Vessel Dis, 2019, 21(1): 103-105. DOI: 10.3969/j.issn.1009-0126.2019.01.027.
[9]	姬翔, 武昊鹏, 张行, 等. 老老年高血压病人24h动态血压特点分析[J]. 中西医结合心脑血管病杂志, 2016, 14(17): 2031-2033. DOI: 10.3969/j.issn.1672-1349.2016.17.025. Ji X, Wu HP, Zhang X, et al. Characteristics of 24-hour ambulatory blood pressure in elderly patients with hypertension[J]. Chin J of Integrative Medicine on Cardio/Cerebrovascular Disease, 2016, 14(17): 2031-2033. DOI: 10.3969/j.issn.1672-1349.2016.17.025.
[10]	陈贻珊, 李俊平, 孔振兴, 等. 动脉硬化对成年人心脏结构、功能及运动变化特征的影响[J]. 中国动脉硬化杂志, 2018, 26(11): 1140-1146. doi: 10.3969/j.issn.1007-3949.2018.11.012 Chen YS, Li JP, Kong ZX, et al. Effects of arteriosclerosis on cardiac structure, function and exercise change performance in adults[J]. Chin J Arterioscler, 2018, 26(11)1140-1146. doi: 10.3969/j.issn.1007-3949.2018.11.012
[11]	廖礼强, 唐金国, 张颖, 等. 中青年H型高血压患者的血压变异性和昼夜节律[J]. 重庆医学, 2018, 47(4): 494-496. DOI: 10.3969/j.issn.1671-8348.2018.04.019. Liao LQ, Tang JG, Zhang Y, et al. Blood pressure variability and circadian rhythms in young and middle-aged people with H-type Primary hypertension[J]. Chongqing Medicine, 2018, 47(4): 494-496. DOI: 10.3969/j.issn.1671-8348.2018.04.019.
[12]	江金锋, 邹文博, 蔡文钦, 等. 正常血压者血压变异性与血压节律的相关性[J]. 中华高血压杂志, 2017, 25(10): 950-955. DOI: 10.16439/j.cnki.1673-7245.2017.10.015. Jiang JF, Zou WB, Cai WQ, et al. The relationship between blood pressure variability and circadiam rhythm in normotensives[J]. Chin J Hypertens, 2017, 25(10): 950-955. DOI: 10.16439/j.cnki.1673-7245.2017.10.015.
[13]	王吉, 伊双艳, 秦爱梅, 等. 老年高血压患者血压晨峰与卒中、左心室肥厚及对颈动脉IMT增厚的关系[J]. 中国循证心血管医学杂志, 2014, 6(2): 156-159. DOI: 10.3969/j.1674-4055.2014.02.09. Wang J, Yi SY, Qin AM, et al. Relationship between morning blood pressure surge and stroke, left ventricular hypertrophy and carotidintima-media thickness in elderly patients with essential hypertension[J]. Chin J Evid Based Cardiovasc Med, 2014, 6(2): 156-159. DOI: 10.3969/j.1674-4055.2014.02.09.
[14]	Zhong Z, Wang L, Wen X, et al. A meta-analysis of effects of selective serotonin reuptake inhibitors on blood pressure in depression treatment: outcomes from placebo and serotonin and noradrenaline reuptake inhibitor controlled trials[J]. Neuropsychiatr Dis Treat, 2017, 7(13): 2781-2796.
[15]	王磊, 程艳梅, 范家玮, 等. 二白汤联合苯磺酸氨氯地平对高血压患者晨峰血压的影响[J]. 上海中医药杂志, 2019, 53(2): 61-63. DOI: 10.16305/j.1007-1334.2019.02.016. Wang L, Cheng YM, Fan JW, et al. Effects of Erbai Decoction combined with amlodipine besylate on morning blood pressure surge in patients with hypertension[J]. SH. J. TCM, 2019, 53(2): 61-63. DOI: 10.16305/j.1007-1334.2019.02.016.