老年高血压患者动态血压与血清尿酸的关系

目的研究老年高血压患者动态血压的特征,血清尿酸等心血管危险因素与动态血压参数、靶器官损伤的关系。方法选取2009年1月—2013年7月的老年高血压住院患者,排除继发性高血压、严重感染及其他严重疾病者。入选患者共243例（平均年龄76.2岁,男性84.0%）,分别行动态血压监测、血液生化检测、颈部动脉及心脏超声检查,根据血压昼夜波动情况分组,分析各组临床及动态血压特征;分析左心室肥厚、颈动脉内膜中层增厚与血清尿酸等心血管危险因素及动态血压之间的关系。结果老年高血压多表现为夜间血压增高,晨峰现象明显。血清尿酸水平与血压节律（β〈0.001,P=0.008）、晨峰（β=0.025,P=0.003）呈正相关。夜间平均收缩压水平与左心室肥厚独立相关（χ2=5.435,P=0.020）;年龄、血清尿酸、动态脉压与颈动脉内膜中层增厚独立相关（χ2=36.578,P〈0.001）。结论对于老年高血压患者,年龄、血清尿酸水平是影响血压昼夜波动的重要因素。血清尿酸与颈动脉内膜中层增厚密切相关,未发现血清尿酸与左心室肥厚的相关性。夜间收缩压水平升高是左心室肥厚的独立危险因素。

Relationship between ambulatory blood pressure and serum uric acid of old patients with hypertension

Objective To explore the characteristics of ambulatory blood pressure of old patients with hypertension and the relationship of cardiovascular risk factors （such as the serum uric acid）, parameters of ambulatory blood pressure, and target organ damage. Methods A total of 243 old inpatients with hypertension （ the average age was 76.2 years and 84. 0% of them were male） who were hospitalized from January 2009 to July 2013 were selected after patients with secondary hypertension, severe infections, or other severe diseases were excluded. Patients underwent the ambulatory blood pressure monitoring （ABPM）, biochemical tests of blood, and ultrasound examinations of the heart and carotid arteries. Patients were divided into groups according to their patterns of blood pressure fluctuation. The clinical and ambulatory blood pressure characteristics of each group were analyzed. The relationship of cardiovascular risk factors （ such as left ventricular hypertrophy, intima-media thickening of carotid artery, and serum uric acid） and ambulatory blood pressure was also analyzed. Results The elderly hypertension was characterized by nocturnal hypertension and marked morning blood pressure surge. The serum uric acid level was positively correlated to the rhythm of blood pressure （fl （0. 001, P =0. 008） and morning blood pressure surge （/3 =0. 025, P = 0. 003）. Average nocturnal systolic blood pressure level was independendy correlated to left ventricular hypertrophy （x2 =5. 435, P =0. 020）. Age, serum uric acid, and ambulatory pulse pressure were independently correlated to intima-media thickening of carotid artery （x2 =36.578, P〈0. 001）. Conclusion Age and serum uric acid level are important factors that influence the circadian fluctuations of blood pressure of old patients with hypertension. Serum uric acid is closely correlated to intima-media thickening of carotid artery, but not correlated to left ventricular hv-oertroohy. Increased nocturnal systolic blood pressure is an independent ris