动态脉压与老年高血压合并脑梗死及颈动脉硬化的关系

目的研究老年高血压患者动态脉压（PP）与脑梗死及颈动脉粥样硬化的关系，为临床有针对性的干预PP、预防高血压并发症提供理论基础。方法对老年高血压及老年高血压合并脑梗死的动态PP进行比较，同时对老年高血压颈动脉内膜中层厚度（IMT）增厚组与正常组的动态PP进行比较。结果1）与单纯高血压组比较，高血压合并脑梗死组的24h动态脉压（24hAPP）、白昼脉压（dPP）、夜间脉压（nPP）水平显著增大，24h平均收缩压（24hASBP）、夜间平均收缩压（nSBP）水平显著升高，24h平均舒张压（24hADBP）、白昼平均舒张压（dDBP）、夜间平均舒张压（nDBP）水平显著下降，而两组间dSBP比较无统计学意义；2）老年高血压患者IMT增厚组的24hAPP、dPP和nPP水平均显著增高于IMT正常组；3）与动态PP〈60mmHg者比较，动态PP≥60mmHg的高血压患者脑梗死发生率显著升高；4）与动态PP〈60mmHg者比较，动态PP≥60mmHg的单纯高血压患者的IMT显著增厚。结论动态PP增大是老年高血压患者颈动脉粥样硬化及未来发生脑梗死的重要危险因素。

Relationship of ambulatory pulse pressure with cerebral infarction and carotid atherosclerosis in elderly patients with essential hypertensive

Objective To investigate the relationship of ambulatory pulse pressure with cerebral infarction and carotid atherosclerosis in elderly hypertensive patients. Methods 24h ambulatory blood pressure was measured in a total 312 elderly patients with essential hypertensive （EH）, including 153 patients with simple EH and 159 subjects with EH complicated with cerebral infarction. Ambulatory PP, systolic blood pressure （SBP） and diastolic blood pressure （DBP） were compared between two groups. The hypertensive patients without cerebral infarction were further divided into 2 subgroups according to carotid artery intima-media thickness （IMT, 〈0.9 mm into normal IMT group,≥0. 9 mm into thick IMT group） and ambulatory PP was compared. Results （1） The group of EH complicated with cerebral infarction had higher 24h ambulatory PP, diurnal PP and nocturnal PP （P 〈 0.01）, higher 24h ambulatory SBP （P 〈0.05） and nocturnal SBP （P 〈0. 01）, lower 24h ambulatory DBP, diurnal DBP and nocturnal DBP （P 〈0.01） than the group of EH without cerebral infarction; （2） 24h ambulatory PP, diurnal PP and nocturnal PP of thick IMT group were significantly higher than those of normal IMT group （P 〈0.01） ; （3） The presence of cerebral infarction was significantly higher in hypertensive patients with ambulatory PP≥60 mmHg than that in those with ambulatory PP〈60 mmHg （58. 51% vs. 39. 52%, P 〈0.01）;（4） Carotid IMT was significantly higher in simple hypertensive patients with ambulatory PP≥60 mmHg compared with those with ambulatory PP〈60mmHg （P 〈0.01） . Conclusions Augmentation of ambulatory PP is one of the important risk factors responsible for development of early atherosclerosis and subsequent occurrence of cerebral infarction in elderly hypertensive patients .