动态血压监测评价老年高血压患者靶器官损害

目的探讨动态血压监测对老年高血压患者靶器官损害的价值.方法对232例已经接受服药治疗并且至少伴有一个靶器官损害的老年高血压患者进行24 h动态血压监测,根据累及靶器官损害数目和并存心脏、脑和肾脏临床状况分为3组,结合临床资料进行统计学分析.结果靶器官损害数目与24 h平均收缩压、夜间平均舒张压、血压波动的昼夜节律异常和血压负荷增高密切相关,靶器官损害累及3个器官与累及1个器官相比差异有统计学意义（P＜0.01）;并存脑血管疾病组夜间平均舒张压增高显著,并存心血管疾病组和肾脏病变组的患者以24 h平均收缩压增高和血压负荷增加显著,并存临床状况的患者,血压波动的昼夜节律异常多见,并存心、脑和肾临床状况组分别与靶器官损害组相比差异有统计学意义（P＜0.01）.结论24 h平均收缩压、夜间平均舒张压和血压负荷越高,靶器官损害数目越多;血压波动的昼夜节律异常多见于并存临床状况的老年高血压患者,应用动态血压监测有助于指导临床治疗.

Evaluation of the target-organ damage in the elderly hypertension patients by ambulatory blood pressure monitoring

Objective To explore the prognostic value of 24 h ambulatory blood pressure monitoring (ABPM)for target organ damage (TOD) in the elderly hypertension patients. Methods Two hundred and thirty two elderly hypertension patients who were involved at least one target- organ damage experienced 24 h ABPM. All subjects were randomly divided into 3 groups according to the number of TOD and the clinical situation of cardiovascular, cerebrovascular and renal complications. 24 h ABPM recordings of each group were compared with one another. Results The number of TOD were highly correlated with 24 h average systolic pressure, nighttime average diastolic pressure, abnormal circadian rhythm and pressure burden. The difference was significant between patients involved 3 TOD and those with 1 TOD(P<0.01). The night average diastolic pressure of the patients with cerebovascular complications was significantly higher, whereas. 24 h average blood pressure and pressure burden of the patients with cardiovascular and renal complications were significantly higher. Abnormal circadian rhythm was more observed in patients with clinical complications. Compared with TOD group, the groups with clinical complications had significant difference(P<0.01 ). Conclusions With the heightening of 24 h average systolic pressure, nighttime average diastolic pressure and pressure burden, the more TOD can be observed. The elderly hypertension patients with clinical complications often present abnormal circadian rhythm. ABPM is a helpful guidance for the clinical evaluation of elderly hypertension.