老年高血压患者亚临床甲状腺功能减退与血压变异性的关系

目的探讨亚临床甲状腺功能减退(亚甲减)的老年高血压患者每日血压变异性(BPV)指标特点及与亚甲减的关系。方法共纳入260例老年高血压患者,其中129例合并亚甲减,131例甲状腺功能正常者作对照,采集患者身高、体重、诊室坐位血压、血甲状腺功能指标、空腹血糖(FBG)、糖化血红蛋白、血脂、高敏C反应蛋白、血尿酸、同形半胱氨酸等指标,同时作24 h动态血压监测。结果亚甲减组与甲功正常组比较,夜间收缩压、清晨收缩压、反杓形节律构成比更高(P<0.05),杓形节律构成比、舒张压夜间下降率更低(P<0.05)。多元逐步回归分析显示:即便排除其他因素影响,清晨收缩压仍与游离三碘甲状腺原氨酸(FT3)负相关,与促甲状腺激素(TSH)正相关;清晨舒张压与年龄负相关,与体重、TSH正相关;夜间收缩压下降率与FBG负相关,与FT3正相关;夜间舒张压下降率与FT3正相关。结论老年高血压患者BPV增大与亚甲减密切相关。

Relationship between subclinical hypothyroidism and blood pressure variability in elderly patients with essential hypertension

Objective To investigate characteristics of daily blood pressure variability(BPV) in elderly hypertensive patients with subclinical hypothyroidism and explore the relationship between BPV and subclinical hypothyroidism.Methods A total of 260 elderly hypertension patients were included, 129 patients with subclinical hypothyroidism and 131 euthyroid controls. Height, body mass, clinic blood pressure, serum thyroid function index,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1 c),blood lipid level, high-sensitivity C-reactive protein,uric acid and homocysteine were collected. All cases underwent 24 h ambulatory blood pressure monitoring.Results Compared with normal control group, in subclinical hypothyroidism patients, levels of nocturnal systolic blood pressure(SBP), morning SBP and reverse dipper ratio were higher(P<0.05), while dipper ratio and nocturnal dip of diastolic blood pressure(DBP)were lower in(P<0.05). Multiple stepwise regression analysis revealed that even other factors were excluded, the morning SBP was negatively correlated with free triiodothyronine(FT3) and positively correlated with thyroid stimulating hormone(TSH), the morning DBP was negatively correlated with age and positively correlated with body mass and TSH, furthermore, nocturnal dip of SBP was negatively correlated with FBG and positively correlated with FT3, nocturnal dip of DBP was positively correlated with FT3.Conclusions The increased BPV is closely related with subclinical hypothyroidism in elderly hypertensive patients.