动态血压监测在高血压靶器官损害中的应用价值

目的 探讨动态血压监测（ＡＢＰＭ）在高血压（ＥＨ）靶器官损害（ＴＯＤ）中的应用价值。方法 对１３２５例资料完整符合入选标准的ＡＢＰＭ结果进行分析。结果 （１）血压正常者１０６例，单纯ＥＨ４９８例，合并ＴＯＤ７２１例，其中５３％心脏损害，１６％脑损害，９％肾损害，２２％多脏器损害。（２）ＥＨ患者ＴＯＤ随着年龄的增加而增多，男性更易出现心脏和脑的损害。（３）动态血压（ＡＢＰ）对ＥＨ患者ＴＯＤ的发生比偶测血压有更紧密的联系，随着ＡＢＰ的增高、昼夜规律的紊乱、血压负荷的增加，ＴＯＤ增多。（４）当ＡＢＰＭ白天〉１８／１１．３３ｋＰａ，夜间睡眠〉１６／１０ｋＰａ时，ＴＯＤ明显增多。（５）动态收缩压变化对脑影响明显，舒张压变化对肾影响明显，部分心绞痛患者可能与夜间血压升高有关，而左室肥厚可能在ＴＯＤ中出现较早。（６）ＡＢＰＭ

Application of Ambulatory Blood Pressure Monitoring in Essential Hypertension with Target Organ Damage

Objective Method Ambulatory blood pressure(ABPM) results in 1325 cases with reliable data according with the selected criteria have been investigated. Results (1) 106 normotensives,498 hypertensives without target organ damage(TOD) and 721 hypertensives with TOD were included in the study,53% cardiac damage,16% cerebral damage,9% renal damage and 22% more than one {organ} damage were found in the TOD group. (2)With getting old,TOD was increased. Cardiac and cerebral damages found more often in men than in women. (3) TOD was more closely related to ABP than that to casual BP; TOD was increased along with a raised ABP,a disturbance of day|night BP change. (4) TOD was increased when mean daytime ABP>18/11 33 kPa and/or mean nighttime ABP>16/10 kPa. (5)The brain was susceptible to ambulatory systolic BP values. Some patients with angina would be associated with a raised nocturnal BP. Left ventricular hypertrophy would seem to appear in the early stage of TOD,while renal damage could take place in late hypertension. Conclusion The normal ABP criteria determined by the sixth report of JNC in USA is suitable for Chinese patients with essential hypertension. ABPM may play an important role in guiding the choice of dosage and duration in drug therapy.;