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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
邱萌,朱昀,张福春,张帆.老年高血压病患者治疗达标后血压昼夜节律变化特点及影响因素[J].中华老年多器官疾病杂志,2018,17(3):192~196
老年高血压病患者治疗达标后血压昼夜节律变化特点及影响因素
Alteration characteristics and influencing factors of circadian rhythm of blood pressure in the elderly with well-controlled hypertension
投稿时间:2017-10-30  修订日期:2017-12-14
DOI:10.11915/j.issn.1671-5403.2018.03.042
中文关键词:  老年人;高血压;24小时动态血压监测;血压昼夜节律;杓型血压
英文关键词:aged; hypertension; 24-hour ambulatory blood pressure monitoring; circadian rhythm of blood pressure; dipper blood pressure
基金项目:
作者单位E-mail
邱萌 北京大学第三医院老年内科,北京 100191  
朱昀 北京大学第三医院老年内科,北京 100191 zhuyun14@hotmail.com 
张福春 北京大学第三医院老年内科,北京 100191  
张帆 北京大学第三医院老年内科,北京 100191  
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中文摘要:
      目的 研究老年高血压病患者治疗达标后血压昼夜节律变化特点及影响因素。方法 连续选取2016年1月至2017年3月在北京大学第三医院老年内科住院治疗并治疗达标的高血压病患者,对其进行24 h动态血压监测,根据夜间血压下降率分为3组:杓型血压组(n=48)、非杓型血压组(n=91)和反杓型血压组(n=73)。比较各组间基础资料、血压监测数值、生化指标及靶器官损害情况。采用SPSS 17.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ2检验。采用多因素logistic回归分析筛选出影响杓型血压的独立危险因素。结果 与杓型血压组比较,非杓型血压组和反杓型血压组患者的年龄[(78.96±6.86) vs(82.59±5.85) vs(75.75±7.43)岁]更高、体质量指数(BMI)[(25.23±3.57) vs(25.01±3.76) vs(22.43±2.62)kg/m2]更大、有脑血管病史(17.6% vs 35.6% vs 14.6%)的患者更多、夜间平均收缩压[(123.04±15.67) vs(137.19±19.11) vs(111.31±12.30)mmHg (1 mmHg=0.133 kPa)]和夜间平均舒张压[(64.88±8.02) vs(69.18±9.76)vs(61.38±7.48)mmHg]更高,差异均具有统计学意义(P<0.05);与杓型血压组比较,反杓型血压组患者的肌酐清除率[(57.59±12.89) vs(48.59±13.86)ml/min]显著降低(P<0.05)。非杓型血压组和反杓型血压组患者中有颈动脉斑块的人数比例显著高于杓型血压组(90.1% vs 97.3% vs 72.9%,P<0.05)。logistic多因素回归分析结果显示:年龄(95%CI:1.35~5.95,P=0.006)、BMI(95%CI:1.43~5.91,P=0.003)、颈动脉斑块(95%CI:1.25~5.12,P=0.010)为影响杓型血压的独立危险因素。结论 血压治疗达标的老年高血压病患者仍存在血压昼夜节律异常。
英文摘要:
      Objective To investigate the alteration characteristics and the influencing factors of the circadian rhythm of blood pre-ssure in the senile patients with well-controlled hypertension. Methods A total of 215 consecutive senile patients with hypertension well controlled who were hospitalized in our Department of Geriatrics from January 2016 to March 2017 were enrolled in this study. The 24-hour ambulatory blood pressure monitoring was performed on all patients, and according to their decline rate of nocturnal blood pre-ssure, they were divided into 3 groups:dipper blood pressure group (n=48), non-dipper blood pressure group (n=91) and anti-dipper blood pressure group (n=73). The baseline information, results of ambulatory blood pressure, results of biochemical blood examination, and target organ damage were compared among the 3 groups. SPSS statistics 17.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed to analyze different data types. Multiple logistic regression analysis was used to screen the independent risk factors for dipper blood pressure. Results Compared with the dipper blood pressure group, the non-dipper and anti-dipper blood pressure groups had significantly older age [(78.96±6.86) vs (82.59±5.85) vs (75.75±7.43)years], higher body mass index [(25.23±3.57) vs (25.01±3.76) vs (22.43±2.62)kg/m2], higher ratio of patients with cerebrovascular disease history (17.6% vs 35.6% vs 14.6%), and higher nocturnal systolic [(123.04±15.67) vs (137.19±19.11) vs(111.31±12.30)mmHg, 1 mmHg=0.133 kPa] and diastolic blood pressure [(64.88±8.02) vs (69.18±9.76) vs (61.38±7.48)mmHg, all P<0.05]. Creatinine clearance rate (CCr) was obviously lower in the anti-dipper group than the dipper blood pressure group [(48.95±13.86) vs (57.59±12.89)ml/min, P<0.05]. There were more patients having carotid atherosclerotic plagues in the non-dipper and anti-dipper groups than the dipper blood pressure group (90.1% vs 97.3% vs 72.9%, P<0.05). Multiple logisticregression analysis showed that age (95%CI:1.35-5.95, P=0.006), BMI (95%CI:1.43-5.91, P=0.003) and carotid plaque (95%CI:1.25-5.12, P=0.010) were independent risk factors for dipper blood pressure. Conclusion Abnormal circadian rhythm of blood pressure are still seen in the elderly patients with well-controlled hypertension.
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