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
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- 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

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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)

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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

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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。

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