高同型半胱氨酸血症对老年高血压患者血压变异性及内皮素的影响

目的：探讨高同型半胱氨酸血症(HHcy)对老年高血压患者血压变异性(BPV)及内皮素(ET)的影响。方法对2014年1~8月在我院就诊的116例老年高血压患者进行血浆Hcy、ET检测和动态血压测定，根据Hcy检测结果分为Hcy中度升高组30例；Hcy轻度升高组33例；正常Hcy组53例；观察并比较各组患者的血浆ET和BPV的变化情况。结果(1) Hcy中度升高组的24 h收缩压变异(24 h SBPV)、日间收缩压变异(dSBPV)、日间舒张压变异(dDBPV)、夜间收缩压变异(nSBPV)分别为(13.95±3.65)%、(13.34±3.84)%、(14.32±4.84)%、(12.03±2.84)%，Hcy轻度升高组分别为(11.10±2.81)%、(9.87±3.25)%、(11.90±3.80)%、(10.58±2.61)%，正常Hcy组分别为(9.72±2.15)%、(8.23±2.14)%、(9.47±2.62)%、(9.65±2.31)%，Hcy中度升高组均高于Hcy轻度升高组，Hcy轻度升高组均高于正常Hcy组，差异均有统计学意义(P<0.05)；(2) Hcy轻度升高组及中度升高组的血浆ET分别为(80.51±4.58) pg/mL、(87.69±4.92) pg/mL，正常Hcy组为(68.90±5.17) pg/mL，Hcy中度升高组血浆ET高于轻度升高组，轻度升高组高于正常Hcy组，差异均有统计学意义(P<0.05)；(3) Hcy轻度升高组的Hcy水平与24 h SBPV、dSBPV、dDBPV和nSBPV呈正相关(r分别为0.463、0.443、0.456、0.448，P均<0.01)；Hcy中度升高组的Hcy水平与24 h SBPV、dSBPV、dDBPV和nSBPV呈正相关(r分别为0.487、0.471、0.479、0.484，P均<0.01)；(4) Hcy轻度升高组和中度升高组的Hcy水平与ET水平呈正相关(r分别为0.453、0.487，P<0.01)。结论随着老年高血压患者血浆同型半胱氨酸水平的增高，血压变异性及内皮素水平明显增高，这将直接加重血管损伤，增加靶器官损害及血管性疾病发生风险，因此在老年高血压病人的治疗中，不仅要关注血压水平，同时要积极干预高Hcy，控制血压波动，降低心脑血管事件发生率与总体死亡危险。

Effect of hyperhomocysteinemia on blood pressure variability and endothelin in elderly patients with hypertension

Objective To investigate the effect of hyperhomocysteinemia (HHcy) on blood pressure variability (BPV) and endothelin (ET) in elderly patients with essential hypertension. Methods A total of 116 elderly patients with hypertension in our hospital were detected for plasma homocysteine (Hcy), ET and blood pressure from January 2014 to Au-gust 2014. The patients were divided into three groups according to the levels of Hcy:moderate elevation group (n=30), mild elevation group (n=33), normal group (n=53). The changes of blood pressure and endothelin were compared be-tween the three groups. Results (1) 24 hour systolic blood pressure variability (SBPV), day systolic blood pressure variability (dSBPV), day diastolic blood pressure variability (dDBPV) and night systolic blood pressure variability (nSBPV) in moderate elevation group were significantly higher than those in mild elevation group, followed by normal group, (13.95 ± 3.65)% vs (11.10 ± 2.81)% vs (9.72 ± 2.15)%; (13.34 ± 3.84)% vs (9.87 ± 3.25)% vs (8.23 ± 2.14)%; (14.32 ± 4.84)%vs (11.90±3.80)%vs (9.47±2.62)%;(12.03±2.84)%vs (10.58±2.61)%vs (9.65±2.31)%, P<0.05. (2) The plasma of ET in mild elevation group, moderate elevation group and normal group were (80.51±4.58) pg/mL, (87.69±4.91) pg/mL, (68.90±5.17) pg/mL, respectively, which was significantly higher in moderate elevation group than mild elevation group, and mild elevation group than normal group (P<0.05). (3) 24 h SBPV, dSBPV, dDBPV and nSBPV were positively corre-lated with the levels of Hcy in mild elevation group (r=0.463, 0.443, 0.456, 0.448, P<0.01). 24 h SBPV, dSBPV, dDBPV and nSBPV were positively correlated with the levels of Hcy in moderate elevation group (r=0.487, 0.471, 0.479, 0.484, P<0.01). (4) The levels of ET were positively correlated with the levels of Hcy in mild elevation group and moderate ele-vation group (r=0.453, 0.487, P<0.01). Conclusion With the increase of plasma homocysteine levels in elderly patients with essential hypertension, the levels of blood pressure variability and endothelin are significantly increased. This will di-rectly increase the vascular injury, and increase the risk of target organ damage and vascular diseases. Therefore, we should not only focus on the level of blood pressure, but also actively intervene hyperhomocysteinemia, control the fluctuation of blood pressure, reduce the incidence of cardiocerebrovascular events and the overall risk of death in the treatment of elderly patients with hypertension.