高龄老年高血压患者颈动脉内膜中膜厚度与动态血压参数的关系

目的 探讨高龄老年高血压患者颈动脉内膜中膜厚度(IMT)及其与动态血压参数特点相关性的研究.方法 将205例患者根据颈动脉超声检查结果分为3组:对照组为非颈动脉内膜中膜增厚(IMT＜1.0 mm),硬化组颈动脉内膜中膜增厚(1.0 mm＜IMT＜1.2 mm),斑块组为颈动脉内膜中膜增厚合并斑块(IMT≥1.2 mm),应用无创24 h动态血压监测系统记录24 h平均收缩压、24 h平均舒张压、白天平均收缩压、白天平均舒张压、夜间平均收缩压、夜间平均舒张压、24 h脉压及白天脉压、夜间脉压值,记录其中杓型高血压和非杓型高血压的比例和合并冠心病比例.用各组IMT均值与24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h脉压、白天脉压、夜间脉压及冠心病发生率作相关分析.结果 斑块组和硬化组24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h脉压、白天脉压及夜间脉压均高于对照组(P＜0.05).其中非杓型高血压在对照组中占54.3%，在硬化组占62.9%,斑块组占77.6%,差异有统计学意义(P＜0.05).各组冠心病发生率对照组为42.1%,硬化组为53.1%,斑块组89.5%,差异有统计学意义(P＜0.05).各组IMT均值与冠心病发生率及24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h脉压、白天脉压和夜间脉压均呈正相关(r值分别为r=0.878,r=0.487,r=0.514,r=0.469,=0.448,r=0.492,r=0.435,P＜0.05).结论 高龄老年高血压患者动态血压的平均收缩压升高、平均脉压增大和血压昼夜节律消失是造成颈动脉内膜中膜厚度增厚及斑块形成的重要因素.颈动脉内膜中膜厚度斑块形成与冠心病的发生有良好的相关性.

The Relationship Between Ambulatory Blood Pressure Monitoring(ABPM) Parameters and Carotid Artery Intima-Media Thickness(CA-IMT) in Elderly Hypertensive Patients

Aim To discuss the relationship between ambulatory blood pressure monitoring(ABPM) parameters and carotid artery intima-media thickness(CA-IMT) in elderly hypertensive patients. Methods According to the results of carotid artery ultrasound examination the 205 patients divided into three groups:the patient were classified into the non-increased IMT group(control group)(IMT<1.0 mm),the increased IMT group(1.0 mm P><0.05).The incidence of coronary heart disease were 42.1% in the non-increased IMT group,53.1% in the increased IMT group,89.5% in the increased IMT with plaque group.The percent of dippers was 54.3%,62.9%,77.6% in each group.Which had significantly difference(P><0.05). The mean IMT had a positive correlation with 24hSBP,dSBP,nSBP,24hPP,dPP,nPP and the incidence of coronary heart disease(r=0.487,r=0.514,r=0.469,r=0.448,r=0.492,r=0.435,r=0.878,P><0.05).Which had significantly difference(P><0.05). Conclusion The rising of 24 hSBP,nSBP,24 hPP,nPP and patients who have lost the normal dipper rhythm of ambulatory blood pressure obviously will lead to the increase of IMT and the rising of plaque formation,which had a good correlation with the occurrence of coronary hart disease.