北京城区老年人血压变异性特点及相关因素的研究

目的 探讨北京城区老年人长时血压变异性的特点及其相关因素.方法 采用整群随机抽样方法在北京市东城区（原崇文区）和石景山区抽取≥60岁非脑卒中人群,对其进行体格检查并随访血压值,分析老年人长时血压变异性特点,运用多重线性回归法探讨血压变异性的相关因素.结果 老年高血压人群（593例）血压变异性明显高于老年非高血压人群（801例）收缩压变异性为（13.8±2.1）mmHg（1 mmHg=0.133 kPa）比（12.0±2.1）mmHg,t=-13.89,P＜0.01;舒张压变异性为（9.3±1.7） mmHg比（8.6±1.8）mmHg,t=-8.45,P＜0.01].男性收缩压＜120、120～139、140～ 159、160～179、≥180 mmHg者分别为93、322、74、9、6例,其收缩压变异性分别为（10.8±2.4）、（12.4±1.9）、（13.6±2.4）、（16.1±2.4）、（23.9±4.5） mmHg,女性分别为463、310、86、28、3例,其收缩压变异性分别为（11.6±2.4）、（12.7±2.0）、（14.2±2.4）、（17.5±2.6）、（26.2±1.8） mmHg.男性舒张压＜80、80～89、90 ～99、100～ 109 mmHg、≥110 mmHg者舒张压变异性分别为（8.4±1.9）、（8.7±1.7）、（9.6±1.5）、（10.2±1.3）、（13.5±5.0） mmHg,女性分别为（8.8±1.7）、（8.9±1.6）、（9.6±1.3）、（10.7±1.0）、（15.6±0.8）mmHg.男性60～64、65 ～69、≥70岁者分别为172、129、203例,其收缩压变异性分别为（11.9±2.7）、（12.1±2.1）、（13.2±2.7）mmHg,舒张压变异性分别为（8.5±1.8）、（8.6±1.8）、（9.1±1.9）mmHg;女性60 ～ 64、65～69、≥70岁者分别为248、270、372例,其收缩压变异性分别为（12.3±2.7）、（12.8±2.1）、（13.4±2.6） mmHg,舒张压变异性分别为（8.7±1.6）、（8.9±1.6）、（9.3±1.8） mmHg;老年人血压变异性有随年龄增大而升高的趋势（P＜0.01）,65 ～69岁组血压变异性高于同龄男性（P＜0.05）.无论男性、女性,老年人血压变异性有随血压水平的升高而增大的趋势;女性收缩压＜ 120 mmHg组、120 ～ 139 mmHg组及舒张压＜ 80 mmHg组血压变异性高于同龄男性（均P＜0.05）.多重线性回归分析结果显示,收缩压水平、高龄、女性、体重指数增加、高脂血症是收缩压变异性的危险因素,舒张压水平、高龄、体重指数增加是舒张压变异性的危险因素,少量饮酒则可能是其保护因素.结论 平均血压水平、年龄、性别、体重指数、高脂血症、少量饮酒是老年人长时血压变异性的相关因素.控制血压水平是降低老年人血压变异性最有效的措施.

Study of characteristics and related factors of blood pressure variability in the elderly in urban area of Beijing

Objective To investigate the characteristics and related factors of long-term blood pressure variability in the elderly in urban area of Beijing.Methods A survey was conducted among a non-stroke population over 60 years old from Dongcheng district （former Chongwen district） and Shijingshan district of Beijing,using stratified cluster random sampling method; physical examination and blood pressure monitoring were taken in each follow-up.Multiple linear regressions were used to analyze the characteristics and related factors of long-term blood pressure variability in the elderly.Results Blood pressure variability in hypertensive patients was significantly higher than that in non-hypertensive patients systolic blood pressure variability was （13.8 ± 2.1） mmHg vs （12.0 ±2.1） mmHg,t =-13.89,P 〈0.01 ; diastolic blood pressure variability was （9.3 ± 1.7） mmHg vs （8.6 ± 1.8） mmHg,t =-8.45,P 〈 0.01].In the groups of systolic blood pressure 〈 120 mmHg,120-139 mmHg,140-159 mmHg,160-179 mmHg,≥ 180 mmHg,systolic blood pressure variability was （10.8 ± 2.4）,（12.4 ± 1.9）,（13.6 ± 2.4）,（16.1 ± 2.4）,（23.9 ± 4.5） mmHg respectively for males,and it was （11.6 ± 2.4）,（12.7 ± 2.0）,（14.2 ± 2.4）,（17.5 ± 2.6）,（26.2 ± 1.8） mmHg respectively for females.In the groups of diastolic blood pressure 〈 80 mmHg,80-89 mmHg,90-99 mmHg,100-109 mmHg,≥ 110 mmHg,diastolic blood pressure variability was （8.4 ± 1.9）,（8.7 ± 1.7）,（9.6 ± 1.5）,（10.2 ± 1.3）,（13.5 ± 5.0） mmHg respectively for males,and it was （8.8 ± 1.7）,（8.9 ± 1.6）,（9.6 ± 1.3）,（10.7 ± 1.0）,（15.6 ± 0.8） mmHg respectively for females.In the groups of age 60-64,65-69,≥70,systolic blood pressure variability was （11.9 ±2.7）,（12.1 ± 2.1）,（13.2 ± 2.7） mmHg respectively for males ; diastolic blood pressure variability was （8.5 ± 1.8）,（8.6 ± 1.8） and （9.1 ± 1.9）mmHg respectively for males.In the groups of age 60-64,65-69,≥70,systolic blood pressure variability was（12.3 ± 2.7）,（12.8 ± 2.1）,（13.4 ± 2.6） mmHg respectively for females,diastolic blood pressure variability was （8.7 ± 1.6）,（8.9 ± 1.6）,（9.3 ± 1.8） mmHg respectively for females.Blood pressure variability in the elderly increased with age （P 〈0.01） ; in the group of age 65-69,blood pressure variability in females was higher than that in males（P 〈0.05）.At the same time,blood pressure variability increased with the increasing mean blood pressure for both sexes; in the groups of systolic blood pressure 〈 120 mmHg,120-139 mmHg and diastolic blood pressure 〈 80 mmHg,blood pressure variability in females was higher than that in males （P 〈 0.05）.Multiple linear regression analysis showed that increasing systolic blood pressure,age,women,increasing body mass index and hyperlipidemia were risk factors of systolic blood pressure variability ; increasing diastolic blood pressure,age and increasing body mass index were risk factors of diastolic blood pressure variability,while light alcohol consumption might be a protective factor.Conclusions Mean blood pressure,age,gender,body mass index,hyperlipidemia and alcohol are main factors affecting long-term blood pressure variability in the elderly.Controlling blood pressure is the most effective measures to reduce blood pressure variability in the elderly.