高血压病人动脉顺应性与家庭偶测血压及动态血压关系

目的　探讨原发性高血压病人家庭测量血压、动态血压与动脉顺应性的关系。方法　共入选 164例受试者 ,其中原发性高血压组 74例 [男 42例 ,女 3 2例 ,平均年龄 ( 4 7 0 5± 10 0 8)岁 ] ;对照组 90例 [男 41例 ,女 49例 ,平均年龄 ( 3 3 81±12 3 5 )岁 ]。对入选者间隔 1～ 3周进行二次家访 ,每次家访由经过专门训练的护士采用汞柱血压计连续测量受试者坐位、左上臂血压 5次 ,每人的家庭测量血压是二次家访、共 10个血压读数的平均值。同时采用SpaceLabs 90 2 0 7动态血压监测仪记录 2 4小时动态血压 ,有效数据应达到 80 %以上。动脉顺应性检查采用动脉脉搏波分析 (PWA)仪。反映大动脉硬化的参数为反射波增强指数 (AIx)。结果　高血压组家庭测量血压及 2 4小时平均收缩压、舒张压、白昼及夜间血压显著高于对照组。与对照组相比 ,高血压组AIx显著升高 ( 2 4 4%± 12 8%vs 12 7%± 18 3 % ,P =0 0 0 0 ) ,经年龄、性别调整后 ,二组间仍有显著性差异 ,提示高血压患者动脉顺应性下降、动脉硬化。将AIx作为因变量 ,年龄、身高、家庭测量血压及动态血压中 2 4小时平均血压、白昼血压、夜间血压、血糖、血酯等作为自变量进行多元回归分析 ,AIx与年龄、家庭血压中的收缩压呈显著的正相关 ,与身高呈负相关

Home-measured Blood Pressure, Ambulatory Blood Pressure Monitoring and Arterial Compliance in Patients with Essential Hypertension

Aim To investigate the relationship among home measured BP, ambulatory blood pressure monitoring(ABPM) and arterial compliance in patients with essential hypertension. Methods One hundred sixty-four subjects were recruited. Blood pressure was measured five times during two home visits by trained nurses after the participants rested for 5 minutes. Ten readings of two home visits were averaged. Ambulatory blood pressure was recorded using SpaceLabs 90207. Pulse waveforms were recorded from the radial artery, and the corresponding central waveforms were generated using pulse wave analysis. Central pressure and augmentation index (AIx, a measure of systemic stiffness) were determined. Results Blood pressure measured at home as well as 24 h average, day and night time ambulatory blood pressure in patients with hypertension were higher than in normotension. Compared with normotension, AIx was higher in hypertension. This difference remained significant after adjustment for age and sex, suggesting that arterial compliance of hypertension was decreased. Multiple regression analysis showed that AIx was positively related with age, home-measured systolic blood pressure and negatively related with body height. Conclusion Arterial compliance in patients with hypertension was decreased, which was positively associated to systolic blood pressure.